191290642-8-16-2023-31-AS-NGID-CW9MNG-20231003094527

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 08/16/2023
Date Signed: 08/16/2023 12:11:55 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
07/18/2023 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20230718141824

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: 123	DATE:	08/16/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Celia Garcia, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff failed to provide a comfortable environment for resident

INVESTIGATION FINDINGS:

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At 10:30am, Licensing Program Analyst (LPA) Angela Panushkina conducted a subsequent visit to this facility to deliver final findings. LPA met with the Administrator and the reason for the visit was explained.

It was reported that few residents, (R7, R8, R9) use profanity on the premises and the staff don’t discipline them. It was also reported that R5 tells lies and inappropriate things about the R1 to other people which is incorrect information. To investigate the allegation, on 08/09/22 LPA Panushkina conducted an initial visit and during that visit LPA interviewed with the Administrator, Business Office Director (BOD), three (3) staff members and ten (10) residents.

During interviews with the Administrator and BOD, LPA was informed that R8 and R9 do not use profanity. LPA was also informed that R7, on the other hand, uses profanity on a daily basis. Although, the facility management and staff, constantly, try to redirect and remind R7 about the house rules, R7 continues to act the same way. 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: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

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-20230718141824

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: 08/16/2023

NARRATIVE

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In addition, seven (7) out of ten (10) residents interviewed did not express any concerns regarding other residents using profanity on the premises. Lastly, during the initial visit, interview with R5 revealed that she/he has no knowledge of R1, and R5 denied ever talking lies or inappropriately speaking about R1. Moreover, interviews with the Administrator, BOD, and nine (9) out of ten (10) residents revealed that they never heard nor witnessed R5 saying inappropriate things about R1. Based on inspection, observation and interviews, there is no sufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No immediate Health and Safety hazard is noted during this visit.

Exit interview conducted and a copy of the 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: 08/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2023

LIC9099 (FAS) - (06/04)

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