191290642-2-8-2023-28-AS-RORN-CP3MM7-20230215084329

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 02/08/2023
Date Signed: 02/08/2023 01:50:54 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
07/16/2021 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210716135823

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:	02/08/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Assistant Administrator Celia Garcia		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility is not providing adequate care to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted a subsequent complaint visit to deliver investigation findings for the above stated allegation. LPA met with Assistant Administrator Celia Garcia and explained the reason for the visit.

The investigation consisted of: During the initial visit conducted on 7/20/21, LPA conducted interviews with Assistant Administrator Celia Garcia, and Residents 2-5 (R2-5). LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1s file and collected copies of facility documents relevant to the investigation. On 2/8/23, LPA collected copies of staff and resident rosters and conducted interviews with Staff 1-3 (S1-3), Resident 1 (R1) and Residents 6-8 (R6-8). LPA reviewed 5 Resident files and collected copies of facility documents relevant to the investigation. LPA additionally conducted a tour of the facility which included observations of a random selection of resident rooms, dining room and facility lobby.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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-20210716135823

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
	VISIT DATE: 02/08/2023

NARRATIVE

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Investigation revealed the following: Regarding allegation, Facility is not providing adequate care to resident, it is alleged that facility staff are unreliable and not providing quality care to residents in care and also not assessing a resident in regards to resident's condition and then providing communication about needs and well being to resident. Interviews conducted with 4 out of 4 staff revealed that facility staff provide timely and adequate care to all facility residents at all times. Staff stated that they are properly trained to assess residents and inform the facility administrator if they notice anything of concern regarding any resident so that they can be reassessed. Assistant Administrator stated that if staff notice that a resident's health is failing or deteriorating they will reassess the resident to ensure that the facility is providing the resident with the care and services that they need. 4 staff stated that there is enough staff on schedule at all times to properly and adequately care for the residents. Staff also stated that all residents have a pull cord that they can use to call a staff over if they need assistance with anything. Interviews conducted with 7 out of 8 residents revealed that they are satisfied with the services received at the facility and stated that the facility staff do provide them with quality care. They stated that they do not have any concerns regarding the care that they receive. 1 resident stated that it is not that the care is inadequate but that since the COVID19 pandemic there has been a high turnover of facility staff and the facility has to use caregivers from the registry at times and it is not the same as the more closer relationships that residents had with staff before the pandemic. LPA reviewed R1's file and did not see doctor paperwork or any documents indicating a change in condition or anything stating that R1 needs a higher level of care. LPA did not observe any documents or notes stating that the resident had been observed to have a change in condition or had been reassessed due to a change in condition. LPA toured a random number of resident rooms and observed resident rooms to be clean, and observed residents to be clean. LPA also observed staff assisting residents in the dining room and staff cleaning rooms throughout the facility. LPA reviewed facility schedule and observed that there is enough staff on schedule to properly oversee facility residents, facility operation and tend to residents daily needs. Based on interviews conducted with facility staff, facility residents, LPA record review and LPA observations, there was not enough supportive evidence to concur with the reported allegation.

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 held. A copy of the report was provided to Assistant Administrator Celia Garcia.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC9099 (FAS) - (06/04)

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