191290642-2-13-2021-28-AS-MVAO-BZDVUZ-20210323164535

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 02/11/2021
Date Signed: 02/13/2021 06:12:29 AM

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
07/08/2020 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200708100945

FACILITY NAME:	LEISURE VALE RETIREMENT HOTEL		FACILITY NUMBER:	191290642
ADMINISTRATOR:	POLITA BARNES		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS		TELEPHONE:	(818) 244-2323
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 73	DATE:	02/11/2021
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Jesse Mota		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility staff is not providing resident with clean linens.
Facility staff did not safeguard resident's property.
Facility is malodorous.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Jesse Mota.

The initial investigation was conducted on 07/16/20. On 07/16/20, at approximately 1:15 P.M, LPA requested documentation relevant to this investigation.

During the course of this investigation, LPA Irra interviewed Assistant Administrators, Staff #1 through Staff #11 (S-1 through S-11). Note: LPA attempted to interview S-5 and S-6. S-5 and S-6 did not return LPA’s call. LPA also interviewed Resident #1 through Resident #7 (R-1 through R-7).

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

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-20200708100945

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: 02/11/2021

NARRATIVE

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Allegation: Facility staff is not providing resident with clean linens. Staff interviews revealed that residents are provided with clean linens. Interviewed staff indicated linens are changed weekly and on a as-needed basis. Interviewed staff indicated that all linens are in good condition. Interviewed staff indicated they have not received any concerns/complaints from Residents regarding the linens. Six (6) out of the seven (7) interviewed Residents indicated staff provide clean linens on a weekly and as needed basis and that the linens are kept in good condition. Interviewed Residents indicated they have not heard other Residents complain about the linens not being cleaned. Staff and Resident interviews do not corroborate this allegation.

Allegation: Facility staff did not safeguard resident's property. Interviewed staff indicated they have not received any complaints nor concerns from Residents property not being safeguarded. Interviewed Staff indicated they are trained in Mandated Reporting and Resident Rights. Six (6) out of the seven (7) interviewed Residents indicated that staff safeguard their property and indicated they are not missing any items they own/personal property. Interviewed Residents indicated they have not heard other Residents complain about staff not safeguarding residents’ property. Staff and Resident interviews do not corroborate this allegation.

Allegation: Facility is malodorous. Interviewed staff indicated they have not received any complaints nor concerns from Residents regarding the facility being malodorous. Interviewed Staff indicated this facility is kept clean and free from odors. Interviewed Staff indicated they have not received any complaints nor concerns from Residents about the facility being malodorous. Six (6) out of the seven (7) interviewed Residents indicated the facility is maintain cleaned and free from odors. Interviewed Residents indicated they have not heard other Residents complaint about the facility being malodorous. Six (6) of the seven (7) interviewed residents indicated they have not observed any smoke coming out from any pipes. Staff and Resident interviews do not corroborate this allegation.

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.

A telephonic exit interview was conducted with the Assistant Administrator, a hard copy was provided via e-mail for signature and Appeal Rights were provided

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 02/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2021

LIC9099 (FAS) - (06/04)

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