191290642-7-24-2023-31-AS-NGID-CV7TSF-20230830145904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 07/24/2023
Date Signed: 07/24/2023 03:51:41 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20230714163510

FACILITY NAME:	LEISURE VALE RETIREMENT HOTEL		FACILITY NUMBER:	191290642
ADMINISTRATOR:	CELIA GARCIA		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS		TELEPHONE:	(323) 697-2248
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 117	DATE:	07/24/2023
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Celia Garcia, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Resident(s) not accorded dignity in their personal relationships with staff, residents, and other persons.

INVESTIGATION FINDINGS:

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At 10:20am Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced complaint visit to investigate the above stated allegation. LPA met with the Administrator and explained the reason for the visit.

During course of the investigation, interviews and record review were made. At 10:20 AM, LPA met with the Administrator and requested resident and staff roster. At 10:25 AM, LPA requested copies of pertinent information which include, but not limited to Physician’s report, Appraisal Needs and Services Plan, Resident Appraisal and Staff training, etc., relevant to the investigation. At approximately 10:35 AM, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 10:40 AM – 1:00 PM, LPA interviewed the Administrator, Business Office Director, three (3) staff members and ten (10) residents.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

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 31-AS-20230714163510

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
	VISIT DATE: 07/24/2023

NARRATIVE

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It was alleged that the facility staff and residents have some animosity, retaliation and negativity towards R1. Interviews with the Administrator, Business Office Director and three (3) staff members revealed that all residents are being treated equally, with respect. Moreover, interviews with nine (9) out of ten (10) residents confirmed that they are being treated very well by the facility staff members. Lastly, all facility staff members and nine (9) residents, interviewed during today's visit, denied having animosity, retaliation or negativity towards R1. Based on information obtained through interviews this allegation is deemed Unsubstantiated.

No deficiencies issued.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Angela Panushkina	TELEPHONE: 747-230-3364
LICENSING EVALUATOR SIGNATURE:	DATE: 07/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023

LIC9099 (FAS) - (06/04)

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