197610032-12-16-2021-31-AS-CHAS-CAVU7D-20220121141948

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 12/16/2021
Date Signed: 12/16/2021 05:27:34 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
12/09/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20211209131907

FACILITY NAME:	LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY		FACILITY NUMBER:	197610032
ADMINISTRATOR:	JESSICA PELAYA		FACILITY TYPE:	740
ADDRESS:	44523 15TH STREET WEST		TELEPHONE:	(661) 941-4578
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	157	CENSUS: 112	DATE:	12/16/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Residents’ diapering needs are not being met

INVESTIGATION FINDINGS:

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LPA Spaeth conducted an unannounced visit to the facility and was greeted by Administrator, Jessica Peleya. LPA stated the purpose of the visit was to continue the investigation of the complaint, residents' diapering needs are not being met. LPA confirmed with Administrator there are twenty-three (23) residents who receive diaper changes each day. On December 15, 2021, LPA interviewed ten residents from 12:30 pm until 3:00 pm. Six of the ten residents stated had to wait over thirty minutes for a diaper change on many occasion. Three residents stated only checked two times a day during the 7:00 am until 7:00 pm shift and one resident stated had to wait over two hours for a diaper change during the evening shift (7:00 pm until 7:00 am). On December 15, 2021, Administrator explained the caregivers are to check on those residents who need assistance with diaper change every two hours. Therefore the allegation stating residents’ diapering needs are not being met is substantiated. Pursuant to Title 22 Division 6 of the CA Code of Regulations, a deficiency was cited (refer to LIC 809-D).

Exit inteview conducted, Appealr Rights discussed, and a copy of the report was issues to Administrator.

Substantiated

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: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

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

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
12/09/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20211209131907

FACILITY NAME:	LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY		FACILITY NUMBER:	197610032
ADMINISTRATOR:	JESSICA PELAYA		FACILITY TYPE:	740
ADDRESS:	44523 15TH STREET WEST		TELEPHONE:	(661) 941-4578
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	157	CENSUS: 112	DATE:	12/16/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident sustained a bed sore while in care.
Facility has an infestation of bed bugs

INVESTIGATION FINDINGS:

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In regard to the allegation, resident sustained a bed sore while in care. On December 15, 2021, LPA confirmed with Administrator there is one resident (R1) who is receiving wound care from Omnis Wound Physicians and hospice care from Quietude Hospice Care. It was alleged that a resident's bed sore was not properly bandaged and was big as a cup. On December 15, 2021 at 1:00 pm, LPA Spaeth and Administrator both observed R1's bed sore was properly bandaged. Both parties observed the wound was not as large as a cup. LPA reviewed resident's records and observed the last visit from Omni Wound Physicians was December 10, 2021. The allegation, resident sustained a bed sore while in care is unsubstantiated.

In regard to the facility has an infestation of bed bugs is also unsubstantiated. On December 15, 2021, LPA & Administrator checked eighteen rooms and did not find bed bugs. LPA also interviewed the maintenance staff member Edwin D. who stated seventy-five percent of the rooms have been treated for bed bugs and stated will make sure all rooms have been treated. Also, LPA questioned ten residents who stated have not seen bed bugs in their room. Therefore, this allegation 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: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

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

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20211209131907

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 12/16/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/28/2021 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411(a) Personnel Requirements - (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator stated a new caregiver will begin training tomorrow. The shift will be 10:00 am to 6:00 pm. The caregiver's additional responsibility will be supervision of the current caregivers. Administrator stated will be hiring an additional caregiver upon determination of a qualified person.
	8 9 10 11 12 13 14	Based upon LPA's interviews of ten residents, licensee failed to ensure the care of residents was met. Six of the ten residents interviewed stated had to wait over thirty minutes for a diaper change. Three residents stated only checked two times a day during the 7:00 am until 7:00 pm shift and one resident stated had to wait over two hours for a assistance.	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: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC9099 (FAS) - (06/04)

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