191290642-11-8-2023-31-AS-NMAN-CY7RJV-20231204120434

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 11/07/2023
Date Signed: 11/08/2023 11:39:59 AM

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
11/01/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20231101143513

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:	11/07/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Aaron Khodorkovsky, Administrator		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are not treating resident with respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegation. LPA met with Administrator Aaron Khodorkovsky and explained the reason for the visit.

It was reported that staff are not treating resident with respect. To investigate this allegation on 11/07/2023 between 3:20pm and 3:45pm. staff interviews were initiated. Interviews revealed that residents are treated with respect and dignity. The personal rights of residents are not infringed upon. Between 3:50 and 4:30 pm, LPA conducted a physical plant tour. During the physical plant tour, LPA observed that staff interact cordially with residents. LPA did not observe staff being rude or disrespectful towards residents.

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

Exit interview conducted and a copy of the report was issued.

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: 11/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023

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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