191290642-8-30-2022-28-AS-RORN-CKCVCG-20221019161906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 08/30/2022
Date Signed: 08/30/2022 02:16:35 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2022 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220825155120

FACILITY NAME:	LEISURE VALE RETIREMENT HOTEL		FACILITY NUMBER:	191290642
ADMINISTRATOR:	JESSE MOTA		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS		TELEPHONE:	(818) 244-2323
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 73	DATE:	08/30/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jesse Loera Mota, Administrator		TIME COMPLETED:	02:25 PM

ALLEGATION(S):

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The facility is not providing a safe environment for the residents.
The facility does not have adequate staffing.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted an unannounced complaint investigation regarding the above stated allegations. LPA met with Administrator, Jesse Loera Mota, and explained the reason for the visit.

The investigation consisted of the following:
LPA obtained copies of Staff & Resident Rosters. LPA reviewed the Personnel Report and interviewed the Administrator, 5 Staff, and 7 Residents.

The investigation revealed the following:
Allegation – The facility is not providing a safe environment for the residents. It was alleged that the facility does not lock the back door which resulted in people on the street coming into the facility. LPA interviewed the Administrator who stated the back and side doors are always locked from the outside to prevent transients from entering.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

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 28-AS-20220825155120

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
	VISIT DATE: 08/30/2022

NARRATIVE

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All the staff interviewed had not seen any outside people come into the facility. The side doors are locked from the outside and when residents go out from there, they cannot re-enter. All visitors sign in through the front desk. Staff are always walking around the facility and monitoring residents to ensure their safety. 7 out of the 7 residents interviewed stated they feel safe at the facility. LPA toured the facility today and tested the side and back doors. The side door to Mariposa St and a back corner door leading to another parking lot are locked from the outside. Residents may exit from the doors but cannot re-enter. Staff indicated that they check the doors during their shifts to ensure they are locked.

Allegation – The facility does not have adequate staffing. It is alleged that the facility does not have enough staff during the nightshift to assist residents should there be an emergency. Administrator feels that there is adequate staffing to assist residents based on their current census. He stated that there are 2 NOC shift staff at all times and 1 on-call staff. They also hire staff from caregiver agencies if needed. The NOC shift staff mainly change the residents diapers and make their rounds. In the event of an emergency, staff have been trained on how to handle different types of emergencies and emergency contact numbers are posted. Residents are able to ambulate out of the facility with minimal assistance, except for 2 who need total assistance. LPA interviewed 7 residents and 2 out of the 7 stated they do not feel there is enough staff in the NOC shift. They observed only 2 staff during that shift and do not feel they will be able to handle about 70 residents during an emergency. The other 5 residents stated the facility has adequate staffing and they are able to ambulate on their own if there is an emergency.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with the Administrator. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022

LIC9099 (FAS) - (06/04)

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