191290642-10-11-2023-31-AS-NMAN-CWNV5Q-20231016160819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 10/11/2023
Date Signed: 10/11/2023 03:15:31 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
06/12/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230612105528

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: 132	DATE:	10/11/2023
		UNANNOUNCED	TIME BEGAN:	09:29 AM
MET WITH:	Brandy Rangel		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not ensure that resident is able to meet with a physician.
Staff do not ensure that resident has transportation as necessary.
Staff do not treat resident with dignity and respect.

INVESTIGATION FINDINGS:

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

Licensing Program Analysts (LPAs) Abeye Duguma, Huma Rahimi and Leslie Ngo-Castaneda conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. LPA met with the Assistant Administrator, Brandy Rangel, and explained the reason for the visit.

--- Staff do not ensure that resident is able to meet with a physician.

It was alleged that staff did not assist Resident #1 (R1) with setting up a doctor’s appointment. To investigate the allegation, on 06/20/2023 LPA interviewed three (03) staff from 11:30 AM – 01:00 PM and interviewed six (06) residents between 1:30 PM to 3:30 PM. On 08/29/2023 at around 12:00 PM, LPA interviewed three (03) additional residents. During interviews with staff, all staff stated that they assist all residents with setting up a doctor’s appointment and have never refused to assist any resident. During interviews with residents, R1 stated staff do not assist them with making doctor’s appointments.
(Cont. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

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 3

Control Number 31-AS-20230612105528

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: 10/11/2023

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

All other residents stated that facility assists them with their doctor’s appointments and have never been refused assistance.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff do not ensure that resident has transportation as necessary.

It was alleged that staff did not assist Resident #1 (R1) with transportation. To investigate the allegation, on 06/20/2023 LPA interviewed three (03) staff from 11:30 AM – 01:00 PM and interviewed six (06) residents between 1:30 PM to 3:30 PM. On 08/29/2023 at around 12:00 PM, LPA interviewed three (03) additional residents. During interviews with staff, all staff stated that facility assists all residents with transportation free of charge up to seven (07) miles and if necessary, assist with contacting third party services to provide transport beyond the seven (07)-mile radius. During interviews with residents, R1 stated facility does provide rides but that they were promised Access and Dail-A-Ride services. All other residents stated that facility assists them with transportation and have never been refused.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

---Staff do not treat resident with dignity and respect.

It was alleged that staff bad mouth Resident #1 (R1) to other residents. To investigate the allegation, on 06/20/2023 LPA interviewed three (03) staff from 11:30 AM – 01:00 PM and interviewed six (06) residents between 1:30 PM to 3:30 PM. On 08/29/2023 at around 12:00 PM, LPA interviewed three (03) additional residents. During interviews with staff, all staff stated they never bad mouth residents and treat all residents with kindness and respect.

(Cont. LIC 9099-C)

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20230612105528

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: 10/11/2023

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

During interviews with residents, R1 stated staff bad mouths them, spreads rumors about them and tells other residents to stay away from R1. All other residents stated that facility staff treat them with respect and dignity.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3