191290642-3-14-2023-28-AS-MVAO-CQMTUE-20230406150212

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 03/14/2023
Date Signed: 03/14/2023 02:09:58 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,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/23/2023 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230123104435

FACILITY NAME:	LEISURE VALE RETIREMENT HOTEL		FACILITY NUMBER:	191290642
ADMINISTRATOR:	CELIA GARCIA		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS		TELEPHONE:	(818) 244-2323
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 91	DATE:	03/14/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Celia Garcia		TIME COMPLETED:	02:09 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident is being mistreated while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 03/14/2023 Licensing Program Analyst (LPA) Troy Agard conducted a subsequent complaint investigation at the above facility to address the following allegation. LPA Agard met with Celia Garcia, Administrator and explained the purpose of this visit was to deliver findings for this complaint.

The investigation consisted of the following: LPA toured the physical plant. LPA conducted interviews and record review. LPA requested the following records: 1) staff roster, 2) resident roster, 3) physician report for R1 and 4) Needs and Services Plan. All records were received at the time of initial visit.

Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 28-AS-20230123104435

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
	VISIT DATE: 03/14/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following…Regarding the allegation: Resident is being mistreated while in care. “It’s being alleged that a resident(s) in care are being treated in a cruel manner.” LPA interviewed 4 out of 37 staff in total. 0 out of 4 confirmed the allegation. All staff interviewed denied the allegation unanimously. During interviews with residents, LPA attempted interviews with 9 out of 91 residents in total. 1 resident was unavailable for an interview. 0 out of 8 confirmed the allegation. All residents interviewed denied being mistreated. R3 states, “I been here for several years. The staff treat me nicely and never witness them mistreating a resident.” R8 states, “I like it here. The staff treat me well. I have never witness them being cruel to anyone including me.”

Based on LPA’s observation, and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of the report was given.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2