197610032-5-9-2022-31-AS-CHAS-CERRVJ-20220525132138

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 05/09/2022
Date Signed: 05/09/2022 04:44:26 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
05/27/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20210527162125

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: 105	DATE:	05/09/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff does not ensure resident toileting needs are met.
Resident is malodourous

INVESTIGATION FINDINGS:

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LPA Spaeth conducted an unannounced visit to the facility regarding a complaint. LPA's temperature was recorded and COVID questions asked. LPA was greeted by the Administrator J. Pelaya and LPA stated the purpose of the visit was to conduct an investigation regarding the allegations: staff does not ensure resident toileting needs are met; and resident is malodourous.

LPA reviewed the resident's file from 10:00 am until 10:20 am. LPA conducted a quick tour of the facility from 10:30 am unti 10:50 am and did not observe any immediate safety issues. LPA interviewed three staff members from 11:00 am until 11:35 am. LPA also interviewed ten residents from 11:30 am until 2:00 pm.

In regard to the allegation, staff does not ensure resident toileting needs are met, LPA Spaeth interviewed three staff members who stated check incontinent residents every one to two hours, and stated residents have not complained about the staff's response to incontinent needs. LPA interviewed ten residents who receive incontinent care who stated has no complaints regarding the care provided. Also residents were asked if

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: 05/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

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-20210527162125

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: 05/09/2022

NARRATIVE

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a staff member refused to change a resident's diaper/depends because it is only soaked with urine. All ten residents stated never heard a staff member make that comment. Therefore the allegation is unsubstantiated.

In regard to the allegation, resident is malodourous is also unsubstantiated. During LPA's interviews of ten residents who receive incontinent assistance, LPA did not smell an odor when speaking to the residents in each room. Also, residents confirmed do not smell an odor because caregivers have assisted resident's with incontinent needs in a timely manner..

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

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2022

LIC9099 (FAS) - (06/04)

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