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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 09/18/2023
Date Signed: 09/18/2023 05:35:57 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
09/01/2023 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20230901124437
FACILITY NAME:LEISURE VALE RETIREMENT HOTELFACILITY NUMBER:
191290642
ADMINISTRATOR:CELIA GARCIAFACILITY TYPE:
740
ADDRESS:413 E. CYPRESSTELEPHONE:
(323) 697-2248
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:199CENSUS: 131DATE:
09/18/2023
UNANNOUNCEDTIME BEGAN:
04:08 PM
MET WITH:Celia Garcia, AdministratorTIME COMPLETED:
05:40 PM
ALLEGATION(S):
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Staff did not prevent residents from gaining access to illegal substances.

Staff did not administer medications as prescribed.

Staff did not notify Law Enforcement of an incident.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced subseqent vist to deliver the findings for the above noted allegation. LPA met with Administrator Celia Garcia. The purpose of the visit was discussed.

It was reported that staff did not prevent resident from gaining access to illegal substances. To investigate this allegation on 9/07/2023, between 9:30am and 3:30pm, staff and resident interviews were initiated. Staff interviews revealed that Resident #1 (R1) was found with a controlled substance in their room. Staff confiscated the controlled substance and told R1 that they can be evicted from the facility for violating the house rules. Moreover, staff did not take appropiate steps to stop or prevent R1 from having access to drugs again, even though they were aware of the situation.

Based on interviews there is sufficient information to support this allegation. Therefore, this allegation is being SUBSTANTIATED at this time.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
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
Control Number 31-AS-20230901124437
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: 09/18/2023
NARRATIVE
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It was alleged that staff did not administer medications as prescribed. To investigate this allegation on 9/07/2023, between 9:30am and 3:30pm, staff and resident interviews were initiated. Staff interviews revealed that the facility only has two medical technicians in the day shift and one medical technician in the night shift. There is not sufficient staff to help administer medications in a timely manner, as prescribed. Furthermore, 10 percent of residents were interviewed and they stated that indeed, medication in not administer as prescribed and that they have to wait many hours to receive it.

Based on interviews there is sufficient information to support this allegation. Thus this allegation is deemed SUBSTANTIATED at this time.

It was reported that staff did not notify Law Enforcement of an incident. To investigate this allegation on 9/07/2023, between 9:30am and 3:30pm, staff and resident interviews were initiated. Staff interviews revealed that indeed law enforcement was not contacted and made aware of a resident in community in possession of a controlled substance. Staff did not believe that law enforcement needed to be involved.

Based on interviews there is sufficient information to support this allegation. Therefore, this allegation is SUBSTANTIATED at this time.

Exit interview conducted and a copy of the report was issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20230901124437
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: 09/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
10/02/2023
Section Cited
CCR
78465(c)(2)
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78465-Incidental medical & dental care (c)(2) Once ordered by the physician the medication is given according to the physician orders


This requirement is not met as evidenced by:
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The administrator will provide in writing how the facililty will provide medications to residents in a timely manner and according to physician orders.
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Based on interviews with staff and residents, the medication is not being dispensed according to doctor orders and in a timely manner.

This poses an immediate health a safety risk to residents in care.
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Request Denied
Type B
10/02/2023
Section Cited
CCR
87468.1(a)(2)
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87468.1-Personal rights of residents in all facilities (a)(2) To be accorded safe, healthful, and comfortable accommodations...



This requirement is not met as evidenced by
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The administrator will provide in writing what steps the facility will take to ensure that residents are adhering to house rules and not bringing in controlled substances into the community.
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Based on staff interviews, the facility did not take appropiate steps to prevent R1 from using and bringing in drugs to the community. This violates house rules and residents personal rights.
This poses an immediate health and safety risk to residents in care.
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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 MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20230901124437
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: 09/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/02/2023
Section Cited
CCR
87211(a)(2)(D)
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87211-Reporting Requirements(a)(2)(D) Any incident which threatens the welfare, safety, or health of resident...shall be reported


This requirement was not met as evidenced by:
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Administrator will submit in writing to licensing how they will ensure that all necessary reporting parties are contacted when an incident that affects the community occurs.
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Based on staff interviews, facility did not report to law enforcement ilegal sustances found in R1's room.

This poses a potential health and safety risk to residents in care.
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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 MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 09/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4