191290642-10-23-2023-31-AS-NMAN-CXS2UB-20231120164205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191290642
Report Date: 10/23/2023
Date Signed: 10/23/2023 04:56:39 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
10/23/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20231023125703

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:	10/23/2023
		UNANNOUNCED	TIME BEGAN:	03:17 PM
MET WITH:	Aaron Khodorkovsky, Interim Administrator		TIME COMPLETED:	04:38 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are not meeting resident's bathing needs.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Rosaura Valenzuela and Licensing Program Manager (LPM) Naira Margaryan conducted an unannounced complaint investigation for the above noted allegation. LPA and LPM met with Aaron Khodorkovsky, Interim Administrator. The purpose of the visit was discussed.

It was reported that facility staff are not meeting resident's bathing needs. To investigate this allegation on 10/23/2023, between 3:20pm and 3:35pm, staff interviews were initiated. Interviews revealed that Staff #1 (S1) washes Resident #1 (R1) daily for an hour and a half. R1 only want S1 to assist them and not other staff.

Based on interviews there is not sufficient information to support this allegation. Therefore, this 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: 10/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2023

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