197604160-10-19-2020-31-AS-JAPL-BUSM82-20201027092221

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197604160
Report Date: 10/19/2020
Date Signed: 10/19/2020 02:55:59 PM

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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2020 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 31-AS-20200316103126

FACILITY NAME:	LEISURE LIVING INC.		FACILITY NUMBER:	197604160
ADMINISTRATOR:	PAM HASHEMI		FACILITY TYPE:	740
ADDRESS:	30822 JANLOR DR.		TELEPHONE:	(818) 879-9944
CITY:	WESTLAKE VILLAGE	STATE: CA	ZIP CODE:	91362
CAPACITY:	6	CENSUS: 6	DATE:	10/19/2020
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Michelle Maurer		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Failure to provide sufficient care and supervision
Failure to provide meals of sufficient quality and quantity
Failure to meet mandated reporting requirements
Failure to treat residents with dignity
Failure to protect residents from intimidation

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Ashley Smith initiated a subsequent complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Michelle Maurer.

During the initial visit conducted on 3/19/2020, the LPA interviewed staff at 1:21pm, 2:15pm, and 4:05pm, and requested documents. The LPA completed the following: interviewed resident family members on 4/16/2020 at 4:46pm, 8/3/2020 at 2:20pm and 2:38pm, and on 8/10/2020 at 1:59pm; interviewed collateral agency staff on 3/19/2020 at 12:59pm and 10/6/2020 at 2:22pm; conducted a facility virtual tour on 8/14/2020 at 4:22pm; interviewed facility residents on 10/6/2020 at 3:24pm and on 10/7/2020 at 4:09pm, 4:13pm, 4:16pm, and 4:27pm; and, interviewed staff on 8/14/2020 at 4:22pm, on 10/6/2020 at 12:02pm and 12:10pm, and on 10/7/2020 at 1:35pm.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

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 7

Control Number 31-AS-20200316103126

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE LIVING INC.	FACILITY NUMBER: 197604160
	VISIT DATE: 10/19/2020

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

Regarding the allegation: Failure to provide sufficient care and supervision
It was alleged that at the result of a child residing in the facility, staff are unable to provide sufficient care to residents. In addition, staff were alleged to being on their phone and not focusing on resident care. Interviews conducted confirmed that whereas a child will occasionally interact with the residents, the facility has adequate staffing to ensure that resident needs are met. Records reviewed, including staffing schedules, demonstrate that there are at least two or more staff per shift. A review of resident appraisals and physician reports confirmed that additional staff is not required at this time. The facility maintains at least a 2:6 staffing ratio at all times, which is adequate support given the needs of the residents. A review of incident reports and interviews revealed no direct correlation between resident injury or negligence at the result of unidentified distractions or due to a child being present at this facility.

Resident and staff interviews, and interviews conducted with resident responsible parties negated the claim that staff have been negligent in providing care of residents at this facility. When questioned about the presence of a child in the facility, information obtained from interviews revealed that a child in the facility would not pose a concern and if anything, would bring pleasure to the residents. Based on the investigation, there is insufficient evidence to support the claim that staff failed to provide sufficient care and supervision. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Failure to provide meals of sufficient quality and quantity
It was alleged that residents are not being fed adequate meals. A review of facility menus details that residents receive three meals a day, not including snacks, and the menu was comprised of varied proteins, fruits, vegetables, and carbohydrates. An unannounced facility tour of the kitchen area revealed varied quantities of perishable and nonperishable food items for resident consumption. The LPA observed both fresh and frozen fruits and vegetables and food was observed to be of good quality at that time. A review of documented weight records for residents did not corroborate the claim that residents have lost substantial weight due to lack of quality food. The LPA could not identify concerns regarding food quality, options, and quantity when conducting interviews. Interviews and records review did not reveal that a resident was prescribed a special diet or supplemental nutrition due to a concern of weight loss. Staff and responsible party interviews, for the most part, noted that resident preferences were taken into consideration when providing meals. Based on the investigation, there is insufficient evidence to support the claim that staff failed to provide meals of sufficient quality and quantity. This allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 7

Control Number 31-AS-20200316103126

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE LIVING INC.	FACILITY NUMBER: 197604160
	VISIT DATE: 10/19/2020

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

Regarding the allegation: Failure to meet mandated reporting requirements
It was alleged that an incident occurred approximately 18 months ago, where a staff member was observed being verbally abusive to a resident. It was alleged that this poor conduct was reported to the Administrator and another collateral agency; however, the Administrator in turn allegedly did not report the verbal abuse to the appropriate agencies. Staff claimed that had a report of verbal abuse been made, if they had observed it, or suspected it, they would have reported it. Information obtained through interviews with staff and resident responsible parties did not align with the claim that specific staff were observed yelling or being disrespectful towards residents. Resident responsible party and resident interviews reported only positive interactions with staff at this facility. An interview with a collateral agency confirmed that they consulted with the Administrator regarding mandated reporter requirements approximately 18-24 months ago; however, statements did not confirm that an allegation of verbal abuse by facility staff was reported. If such an allegation was reported, the collateral agency is also mandated to report to misconduct to the appropriate parties. Had such an allegation been shared, the collateral agency would have notified the appropriate parties, which would have included Community Care Licensing (CCL).

Based on the investigation, there is insufficient evidence to support the claim that Administrator failed to meet mandated reporting requirements. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Failure to treat residents with dignity
It was alleged that staff treated resident #2 (R2) unfairly, as R2 was allegedly shamed for having issues with incontinence. Staff interviews revealed that R2 had a challenging time adjusting to the facility during their first couple months of arrival. Staff confirmed that R2 had accidents, but stated it was due to an adjustment period and that overtime, things improved. Staff denied claims that R2 was treated unfairly or shamed as a result of R2’s behavior. R2’s responsible party only had positive things to say in regard to R2’s time at the facility and regarding interactions with staff. Additional information obtained through interviews with staff and resident responsible parties did not align with the claim that specific staff were shaming or disrespecting residents.

Based on the investigation, there is insufficient evidence to support the claim that staff failed to treat residents with dignity. This allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 7

Control Number 31-AS-20200316103126

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE LIVING INC.	FACILITY NUMBER: 197604160
	VISIT DATE: 10/19/2020

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

Regarding the allegation: Failure to protect residents from intimidation
It was alleged that Resident #1 (R1) was excluded from activities. An interview with facility residents, staff, and resident responsible parties did not align with the claim that R1 or any resident was excluded from group activities. Per interviews, residents are involved in both individual and group activity offerings within the facility and no complaints have been voiced. Additional information obtained through interviews did not align with the claim that staff were retaliating against residents or excluding them from activities. Residents did not communicate feelings of being uncomfortable or unsafe as a result of staff interaction.

Based on the investigation, there is insufficient evidence to support the claim that staff failed to protect residents from intimidation. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. A telephonic exit interview was conducted with Michelle Maurer, and a copy of the report was provided via email for signature.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

LIC9099 (FAS) - (06/04)

Page: 4 of 7

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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/16/2020 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 31-AS-20200316103126

FACILITY NAME:	LEISURE LIVING INC.		FACILITY NUMBER:	197604160
ADMINISTRATOR:	PAM HASHEMI		FACILITY TYPE:	740
ADDRESS:	30822 JANLOR DR.		TELEPHONE:	(818) 879-9944
CITY:	WESTLAKE VILLAGE	STATE: CA	ZIP CODE:	91362
CAPACITY:	6	CENSUS: 6	DATE:	10/19/2020
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Michelle Maurer		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Unlawful eviction

INVESTIGATION FINDINGS:

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

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 31-AS-20200316103126

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE LIVING INC.	FACILITY NUMBER: 197604160
	VISIT DATE: 10/19/2020

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

Regarding the allegation: Unlawful eviction
It was alleged that on 3/9/2020, Resident #1 (R1) was served an eviction on the grounds of insufficient payment and violating general policies and procedures.

Upon initial review of R1's Admissions Agreement, a statement written by R1's responsible party noted that R1 would pay the rate for basic services without future fee increases. As the last page in the Admission’s Agreement has the signature of both R1’s responsible party and the facility designee at the time, it appeared that the facility complied with the notion of no future fee increases. As such, R1 cannot be held to the standard of regular fee increases, as the signed contract stated otherwise. Once this was brought to the attention of this facility, the initial eviction was rescinded and this facility reissued an eviction notice on 8/4/2020 solely based on a violation of general policies. However, the eviction detailed how R1’s responsible party was in violation of facility general policies, not R1. For an eviction to be valid, the eviction notice must explicitly address how a resident's actions are in violation of general policies.

Based on the investigation, there is sufficient evidence to support the claim that the facility issued an unlawful eviction. This allegation is deemed Substantiated at this time.

The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report was provided via email for signature, along with the appeal rights.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 31-AS-20200316103126

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE LIVING INC.	FACILITY NUMBER: 197604160
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/19/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/19/2020 Section Cited CCR 87224(a)(3)	1 2 3 4 5 6 7	Eviction Procedures. The licensee may evict a resident for one or more of the reasons listed ... (3) Failure of the resident to comply with general policies of the facility. Said general policies must be in writing... must be made part of the admission agreement. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator has agreed to do the following: 1. The eviction was rescinded on 9/2/2020. Administrator and staff have since reviewed Regulation 87224. Plan of Correction met.
	8 9 10 11 12 13 14	Based on interview and documentation review, the licensee failed to comply with the section cited above, as an eviction was based upon the actions of a resident responsible party, not the actions of a resident residing at this facility, which poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2020

LIC9099 (FAS) - (06/04)

Page: 7 of 7