191290642-8-29-2024-31-AS-EMIR-DAXUD8-20241112142906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 08/29/2024
Date Signed: 08/29/2024 01:21:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/05/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20230705120309

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:	0	CENSUS: 156	DATE:	08/29/2024
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Brandy Rangel, Assistant Administrator		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Resident was sexually assaulted by another resident while in care

INVESTIGATION FINDINGS:

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At 12:30pm, Licensing Program Analyst (LPA) Angela Panushkina met with the facility Assistant Administrator, Brandy Rangel, to conduct an unannounced subsequent complaint visit to deliver the findings regarding the allegation, listed above. An entrance interview was conducted.

On 07/05/23, a complaint #31-AS-20230705120309 was received by the Woodland Hills Adult & Senior Care Regional Office. Complaint #31-AS-20230705120309 was referred to Community Care Licensing Division’s Investigation Branch (IB) on 07/05/23 as an assignment to investigate the complaint. A complete investigation was conducted by IB Investigator, Peter Zertuche, for Case #LD3123-07267. The investigator reviewed the documents gathered by LPA Melissa Ruiz on 07/06/23 from the facility, reviewed the Glendale Police Department report issued for R2, and interviews were conducted with potential witnesses, facility residents, and facility staff members during the dates of 07/05/23, 07/06/23, 07/19/23, 07/20/23, 07/26/23, 07/27/23, 08/23/23. 08/29/23, and 09/12/23.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

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

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230705120309

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
	VISIT DATE: 08/29/2024

NARRATIVE

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An initial visit was made on 07/06/2023, from 9:20am to 2:30pm, by Licensing Program Analyst (LPA) Melissa Ruiz. Around 10:45am LPA conducted a walk through the facility to ensure the health and safety of resident in care, on this day, no issues were observed. Interviews were conducted with the current administrator and one resident (R1) from 11:00am to 11:45am. Relevant documents were gathered including resident roster, physician reports, appraisal needs and service plans, behavioral notes, staff roster, letters written by R2, an eviction letter for R2 and a copy of the ticket issued against R2 by the City of Glendale Police Department.

During the investigation, it was stated and confirm that R2 is a Registered Sex Offender. It was stated that there were no witnesses to the allegation that R2 sexually assaulted R1. When R1 was interviewed, there were inconsistencies of the alleged assault by R2. Discrepancies included how the incident occurred, when it occurred, and where it occurred. One report stated that R2 was exposed with no bottom clothes, then with clothes, it was reported that it occurred in the hall, then it was in the dining area. It was unanimously stated by staff and residents interviewed that R2 has a history of insulting staff and residents, saying inappropriate things, verbally abusive behavior, regularly shouts bad words, verbally aggressive, and uses a lot of profanity, but all denied seeing the alleged assault by R2 to R1. One () of the five (5) resident and one (1) of the seven (7) staff interviewed, did state they had witnessed R2 go without bottom clothing, allowing himself to be exposed. All the others interviewed denied seeing R2 without any clothing top or bottom.

Based on the investigation conducted by IB Investigator Peter Zertuche, it was determined, there was no corroboration by those interviewed which included, five (5) residents, seven (7) facility staff, Glendale Police Department Report, Long Term Ombudsman representative (LTCO), and the Administrator from the prior placement facility, to affirm that there was lack of care and supervision and R1was alleged to have been sexually assaulted by R2 while in care. Therefore, the finding is Unsubstantiated. The allegation is deemed unsubstantiated per Title 22 Regulations, Division 6, Chapter 8. Although the allegations may have happened or is valid, there is no corroboration that the alleged violations did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024

LIC9099 (FAS) - (06/04)

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