197610032-11-12-2021-31-AS-CHAS-C9Q84R-20211214211133

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 11/12/2021
Date Signed: 11/12/2021 04:47:01 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., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/08/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20211108150903

FACILITY NAME:	LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY		FACILITY NUMBER:	197610032
ADMINISTRATOR:	LABELLA, MARK J		FACILITY TYPE:	740
ADDRESS:	44523 15TH STREET WEST		TELEPHONE:	(661) 941-4578
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	157	CENSUS: 113	DATE:	11/12/2021
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Jessica Palaya		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not notify authorized representative of resident's death
Resident did not have toilet paper
Staff did not return resident's personal property to the authorized representatives

INVESTIGATION FINDINGS:

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LPA Spaeth conducted an unannounced visit and was greeted by Administrator, Jessica Palaya. LPA stated the purpose of the was to conduct a complaint investigation. It was alleged that staff did not notify authorized representative of the resident's death, resident did not have toilet paper, and staff did not return resident's personal property to the authorized representative. LPA Spaeth reviewed resident's file from 11:20 am until 11:30 am and requested copies of resident documents. LPA Spaeth interviewed twelve residents, the Administrator and one staff member from 11:30 am until 1:30 pm.

LPA interviewed the Administrator and previous administrator regarding the death of R1. Both confirmed the previous Administrator and the Los Angeles Sheriff's Department had tried to reach the family member in a timely manner; however the family member returned calls several days after the death of R1. Therefore the allegaion staff did not notify authorized representative on resident's death is unsubstantiated.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

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-20211108150903

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 GARDEN SENIOR ASSISTED LIVING FACILITY	FACILITY NUMBER: 197610032
	VISIT DATE: 11/12/2021

NARRATIVE

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LPA interviewed twelve residents regarding the need for toilet paper. All twelve residents confirmed facility staff provide toilet paper in a timely manner when needed. All twelve residents stated when in need, Receptionist will provide the needed toilet paper. The Administrator and Receptionist both confirmed the facility policy has prevented toilet paper shortage issues. Therefore the allegation, resident did not have toilet paper is unsubstantiated.

LPA Spaeth confirmed with Administrator and previous Administrator that residents' possessions are securely stored in the donation room and family members are made aware the items are available for pick up. Also, LPA was advised R1's family member has not contacted the facility regarding the possessions. Therefore the allegation, staff did not return resident's personal property to the authorized representatives is unsubstantiated.

Exit interview was conducted, appeal rights discussed, and a copy of the report was provided to Administrator.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2021

LIC9099 (FAS) - (06/04)

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