197610032-8-27-2021-31-AS-CHAS-CETU9V-20220527152347

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 08/27/2021
Date Signed: 08/27/2021 06:09:45 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
08/06/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20210806153507

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: 117	DATE:	08/27/2021
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	05:20 PM

ALLEGATION(S):

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Residents on residents’ altercations

INVESTIGATION FINDINGS:

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LPA Spaeth conducted an anannounced complaint visit to the facility. Upon arrival at 9:15 am, LPA's temperature was recorded, COVID questions answered, and LPA signed in. LPA was greeted by the new Administrator Designee, Jessica Pelaya who stated Tannya Quezada's last day was today. LPA stated the purpose of the visit was to continue the investigation of the complaint which states "residents on residents altercations."

LPA conducted ten resident interviews and four staff interviews. The complaint stated two residents were arguing and both picked up chairs and threatened each other. Nine residents and four staff members stated never witnessed this incident . One resident stated might have happened maybe five months ago but cannot remember. Therefore the complaint is unsubstantied at this time.

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: 08/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

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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