197610032-3-30-2022-31-AS-CHAS-CDGSEZ-20220414134930

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 03/30/2022
Date Signed: 03/30/2022 02:41:37 PM

Unsubstantiated

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
03/28/2022 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20220328100409

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:	03/30/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Resident is being illegally evicted.
Resident is being threatened.

INVESTIGATION FINDINGS:

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LPA Spaeth conducted an unannounced visit and was greeted by the Administrator, Jessica Pelaya. LPA's temperature was recorded and LPA answered the COVID questions upon entering the reception area of the facility. LPA stated the purpose of the visit was to investigate two allegations which state resident is being illegally evicted and resident is being threatened.

LPA was greeted by Ted Nelson (Licensee) at 11:00 am and LPA interviewed Licensee from 11:00 am until 11:30 am. LPA also interviewed resident from 11:45 pm until 12:00 pm and LPA interviewed Administrator from 12:05 pm until 12:25 pm. LPA reviewed resident’s file from 12:25 pm until 12:45 pm. LPA conducted a brief physical plant tour from 12:45 pm until 1:10 pm to ensure there were no immediate health and safety issues.

In regard to the allegation, resident is being illegally evicted, LPA spoke to resident (R1) who stated was told by Licensee will need to find a SNF location because facility is unable to provide the care R1 needs at this

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: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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-20220328100409

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: 03/30/2022

NARRATIVE

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time. R1 also stated Licensee stated R1 will need to find a skilled nursing facility within the next thirty days. LPA Spaeth spoke to Licensee. Since R1 had stated to Administrator that R1 needs assistance with a specific health condition, Licensee did state it would be in R1’s best interest to find a skilled nursing facility. Licensee stated staff would provide facility names to R1 so that R1 could find a suitable facility within the next thirty days. However, Licensee stated did not threaten R1 with a thirty day notice during the conversation.

On March 10, 2022 during LPA's visit to the facility, LPA and Administrator spoke to R1 at 4:30 pm regarding R1’s need for additional care relating to a specific health condition. LPA witnessed Administrator explaining to R1 that caregivers cannot physically assist R1 with removal or application of a specific medical device Administrator also stated if R1 feels the need for additional care, there were SNF locations within the area that could be considered.

During LPA’s interview of Administrator at 12:05 pm, LPA asked if Administrator had issued an eviction notice to R1 and Administrator stated no. Therefore, this allegation is unsubstantiated.

In regard to the allegation, resident is being threatened, LPA spoke to Licensee and asked if threatened R1 with a 30 day written or verbal notice of eviction. Licensee stated no. Within the complaint, R1 had stated facility was not “doing anything about locating an acceptable facility.” LPA asked if Administrator had assisted R1 with finding a skilled nursing facility. Administrator provided a fax request dated 3/24/2022. The fax was to a prospective SNF requesting possible admissions for R1.

Also, LPA received a copy of R1’s note to Administrator requesting Administrator’s assistance. Administrator provided names of four SNF locations that Administrator had called for R1 but was told by Admissions staff R1 would not be considered for the location. R1 stated to LPA was looking for a SNF with a designated smoking area and a location that would allow R1 to leave the facility at least four times per day. However, the four locations would not consider a candidate who was a smoker or would want to leave the facility more than four times per day. LPA spoke to R1 who verbally confirmed Administrator did assist R1 by calling the SNF locations. Also, R1 confirmed Administrator's recommendation to visit the SNF location that is adjacent to Leisure Gardens. However, R1 stated to LPA the location does not permit smoking and this would not work for R1. Therefore the allegation is unsubstantiated.

Exit interview 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: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

LIC9099 (FAS) - (06/04)

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