197610032-3-14-2022-31-AS-CHAS-CCYTSH-20220329145911

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 03/14/2022
Date Signed: 03/14/2022 05:26:50 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
03/14/2022 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20220314092508

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: 108	DATE:	03/14/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	05:20 PM

ALLEGATION(S):

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Resident sustained scabies while in care.
Facility has bed bugs

INVESTIGATION FINDINGS:

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LPA Spaeth made an unannounced visit to the facility and observed the COVID signs on the front door. LPA's temperature was taken and recorded. LPA explained the purpose of the visit was to investigate a complaint which states resident sustained scabies while in care and facility has bed bugs. LPA Spaeth conducted a brief physical plant tour from 2:15 until 2:35 to ensure no immediate health and safety issues were noted.

LPA inspected twenty-two (rooms) from 2:45 uintil 3:45 pm. LPA checked all beds, baseboard area, and flooring with a flashlight and found no bed bugs. LPA spoke to eight (8) residents who stated rooms have been treated for bugs and have not seen any bed bugs in the room for over one month. LPA Spaeth interviewed maintenance employee, E. Dollente (S1) at 2:10 pm who stated resident rooms on the second floor have been sprayed. S1 stated there are only five rooms on the first floor which still need to be sprayed and is working to spray the rooms. S1 also stated when resident informs S1 or the Administrator he/she has seen bugs in his/her room, S1 will immediately spray the room.

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: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

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-20220314092508

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: 03/14/2022

NARRATIVE

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LPA also interviewed Administrator, Jessica Pelaya at 2:15 pm who stated has not seen any bed bugs in residents' rooms and has not received any complaints for the last four weeks regarding bed bugs. Therefore the allegation, facility has bed bugs is unsubstantiated.

LPA also asked Administrator if R1 had been diagnosed with scabies. Administrator stated no. Administrator stated R1 had a tele med visit with Doctor Filart but R1 was not diagnosed with scabies. At 4:25 pm, Administrator called pharmacy to see if a medication has been prescribed for R1 to treat scabies. Administrator spoke to pharmacy Tech, Sonnie from Allegiance Care Pharmacy who confirmed with Administrator there was no medication prescribed for treating scabies. Therefore, the allegation stating resident sustained scabies while in care is unsubstantiated.

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

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2022

LIC9099 (FAS) - (06/04)

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