191290642-12-9-2022-28-AS-RORN-CMCN4S-20221222090825

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 12/09/2022
Date Signed: 12/09/2022 04:16:14 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
12/01/2022 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221201092511

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: 89	DATE:	12/09/2022
		UNANNOUNCED	TIME BEGAN:	09:06 AM
MET WITH:	Celia Garcia, Administrator		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff do not respond to resident's call button in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial 10-Day complaint visit to investigate the above allegation.The purpose of the visit was discussed with new Administrator Celia Garcia.

The investigation consisted of: A physical plant inspection of the interior and exterior grounds was conducted. The call light system was tested in 9 rooms. The paging system is operational. Staff (S1-S6) and residents (R1- R9) were interviewed. A copy of the resident roster, incontinence list, non-ambulatory resident list, and Employee List was obtained.

See LIC 9099C for report continuation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

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-20221201092511

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: 12/09/2022

NARRATIVE

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Allegation: Staff do not respond to resident's call button in a timely manner. It is alleged that there have been recent staffing shortages due to COVID-19 virus cases. As a result, residents are requesting assistance via the call light system and are waiting approximately 45 minutes for staff assistance. Whereas, before the wait time was approximately 20 minutes. It was reported that residents who require incontinence assistance are not being assisted in a timely manner. A total of six (6) staff were interviewed all stated they try to respond within 5 -15 minutes, and when they are busy assisting other residents they immediately communicate to the front office staff that they are busy, and other caregivers are paged to the resident that needs assistance. A total of nine (9) residents were interviewed none reported issues with call light response wait times. All residents stated that staff respond within several minutes, but never more than 20 minutes.

According to staff interviews there are approximately 40 residents that require assistance with Activities of Daily Living (ADL), and staff are to respond to the call light within 3-5 minutes. In instances where a resident needs incontinence assistance, they call the front desk and caregivers are sent to the resident's room. There are presently 4 caregiver staff working the AM shift, 3 caregivers in the PM shift, and 3 caregivers in the NOC shift. The facility has experienced staffing shortages recently, but has contracted registry staff to fill the staff shortages.

Based on interviews conducted the investigation revealed that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview was conducted with Administrator Celia Garcia. A copy of the report was issued.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

LIC9099 (FAS) - (06/04)

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