191290642-10-30-2023-31-AS-NMAN-CXS25N-20231120160548

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 10/30/2023
Date Signed: 10/30/2023 01:35:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
10/27/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20231027091706

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: 131	DATE:	10/30/2023
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Brandy Rangel, Assistant Administrator		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Staff removed resident's call light.

Staff did not respond to resident call light timely

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegations. LPA met with Assistant Administrator Brandy Rangel and explained the reason for the visit.

It was reported that staff removed Resident #1 (R1)'s call light. To investigate this allegation, on 10/30/2023 between 11:00am and 11:30am, staff interviews were initiated. Interviews revealed that all resident call lights were removed and upgraded to a pendant system. R1 was given a pendant, along with the rest of the residents, but they refuse to use it. The call light cord was removed on 10/26/23 and placed back inside R1's room the following day. On 10/27/2023, R1 called LPA and confirmed the information that staff stated.
Between 11:30am and 12:15pm, LPA toured facility. LPA looked inside other residents rooms and saw that their call light cord had been removed and were issued pendants.

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

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

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-20231027091706

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LEISURE VALE RETIREMENT HOTEL	FACILITY NUMBER: 191290642
	VISIT DATE: 10/30/2023

NARRATIVE

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It was alleged that staff did not respond to R1's call light timely, To investigate this allegation on 10/30/2023, between 11:00am and 11:30am, staff interviews were initiated. Interviews revealed that a staff member did respond to R1's call light in a timely manner, but that they did not want them to assist. R1 wants a specific staff member to assist them with their activities of daily living, but that staff was not available at the time.

Based on interviews there is not sufficient information to verify this allegation. Thus, this allegation is UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2023

LIC9099 (FAS) - (06/04)

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