191290642-9-25-2023-31-AS-NMAN-D66PFT-20240612111712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 09/25/2023
Date Signed: 09/25/2023 05:41:41 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/20/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20230920090435

FACILITY NAME:	LEISURE VALE RETIREMENT HOTEL		FACILITY NUMBER:	191290642
ADMINISTRATOR:	CELIA GARCIA		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS		TELEPHONE:	(323) 697-2248
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 130	DATE:	09/25/2023
		UNANNOUNCED	TIME BEGAN:	03:25 PM
MET WITH:			TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Due to insufficient staffing residents needs are not met.

INVESTIGATION FINDINGS:

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Liceinsing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegation. LPA met with Administrator Celia Garcia. The purpose of the visit was discussed.

It was reported that due to insufficient staffing residents needs are not met. To investigate this allegation on 9/25/2023, between 11:30am and 1:00pm, staff and resident interviews were initiated. Interviews revealed that staff have resigned and that the facility is trying to fill the vacant positions. Moreover, there are not enough staff to met the needs of residents and this is especially true when many staff call out on the same day. In addition, ten percent of residents interviewed also complained about staff availablity. On 9/25/2023, facility records were reviewed. Records confirmed that there is not sufficient staff to meet all of the residents' needs,

Based on interviews and records review there is sufficient information to support this allegation. Thus, this allegation will be SUBSTANTIATED at this time.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/20/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20230920090435

FACILITY NAME:	LEISURE VALE RETIREMENT HOTEL		FACILITY NUMBER:	191290642
ADMINISTRATOR:	CELIA GARCIA		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS		TELEPHONE:	(323) 697-2248
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 130	DATE:	09/25/2023
		UNANNOUNCED	TIME BEGAN:	03:25 PM
MET WITH:	Celia Garcia, Administrator		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Residents are allowed to smoke inside the facility

Residents are not provided proper food service

Staff do not have proper training

INVESTIGATION FINDINGS:

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Liceinsing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegations. LPA met with Administrator Celia Garcia. The purpose of the visit was discussed.

It was reported that residents are allowed to smoke inside the facility.To investigate this allegation on 9/25/2023, between 11:30pm and 1:00pm, staff and resident interviews were initiated. Staff interviews revealed that residents are allowed to smoke in the back patio. Per staff, residents are not allowed to smoke in the facility. Residents interviews confimed what staff told LPA. Between12:30pm and 1:30pm, facility records were reviewed. Records confirm what staff and residents told LPA that smoking in not allowed inside the facility. Between 3:00pm and 3:30pm, LPA toured the facility and did not see any resident smoking inside the facility, but LPA did see residents smoking in the outside back patio.

Based on observation, interviews, and record review, there is not sufficient information to support this allegation. Therefore, the allegation is UNSUBSTANTIATED at this time. Exit interview conducted and a copy of the report was issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20230920090435

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
	VISIT DATE: 09/25/2023

NARRATIVE

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It was alleged that residents are not provided proper food service. To investigate this allegation on 9/25/2023, between 12;00pm and 12:30pm, LPA observed that residents had sufficient food. In addition, between 3:30pm and 4:00pm, staff interviews were initiated. Staff interviews revealed that there is proper food service being provided. Residents are allowed to have a second serving of food if still hungry, but they are not allowed to have three or four servings of the food. Snacks are available in between meals. Between 4:00pm and 4:15pm, LPA reviewed the menu and meal service alternatives.

Based on observation, interviews, and records review, there is not sufficient information to support this allegation. Thus, the allegation is UNSUBSTANTIATED at this time.

It was reported that Staff do not have proper training. To investigate this allegation on 9/25/2023, between 11:30pm and 1:00pm, staff and resident interviews were initiated. Staff interviews revealed that all staff working at the facility have proper training. Two staff also verified that they received CPR training and medication training. Between 4:15pm and 4:30pm, LPA reviewed copies of staff training records confirming the information revealed from interviews.

Based on interviews and record review, there is not pertinent information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 31-AS-20230920090435

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 09/25/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/09/2023 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411-Personnel Requirements (a) Facility personnel shall be at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The administrator will submit in writing to CCL how they will ensure that sufficient staff are hired to met the needs of residents.
	8 9 10 11 12 13 14	Based on interviews and records review there is not sufficient staff to met the needs of residents. This poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 09/25/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4