191290642-8-4-2023-28-AS-RORN-CUHNY6-20230808105210

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 08/04/2023
Date Signed: 08/04/2023 12:45:36 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/30/2022 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221130130604

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: 121	DATE:	08/04/2023
		UNANNOUNCED	TIME BEGAN:	09:19 AM
MET WITH:	Nilda Mercado - Assistant Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff made sexual gestures to a resident while in care.
Staff made inappropriate comments towards a resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced subsequent complaint visit to determine the validity of the above-mentioned allegations. LPA met with Nilda Mercado (Assistant Administrator) and explained the reason for the visit.

The investigation consisted of the following: On12/01/2022, LPA Glenn Trueman interviewed the Assistant Administrator Nilda Mercado and Administrator, and obtained various documents for Resident 1 (R1). Today's visit, LPA Mora obtained copies of the resident and staff rosters, interviewed Assistant Administrator, Staff 1 - Staff 2 (S1 - S2), Resident 1 - Resident 10 (R1 - R10) and R1's Power of Attorney.

The investigation revealed the following: regarding the allegations "staff made sexual gestures to a resident while in care" and "staff made inappropriate comments towards a resident", it is alleged that the previous Adminitrator made sexual gestures about R1's genital size and has told R1 that "you're the kind of gay man who doesn't like bears". (Continued to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) -981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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-20221130130604

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
	VISIT DATE: 08/04/2023

NARRATIVE

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Staff interviewed denied the allegations and stated that R1 has accused many staff of sexual harassment. The previous administrator last day at this facility was 12/01/2022. Residents interviewed revealed that 9 out of 10 could not corroborate the allegations. The 9 residents described the previous administrator as respectful and professional. R1's Power of Attorney could not corroborate the allegations.

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.

Exit interview held and a copy of the report was provided

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) -981-3969
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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