197610032-8-27-2021-31-AS-CHAS-CETVWS-20220527164826

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 08/27/2021
Date Signed: 08/27/2021 06:06:59 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
02/22/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20210222171452

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):

1
2
3
4
5
6
7
8
9

Residents are threatened while in care.
Facility is not maintaining a comfortable temperature for residents
Residents dietary plan is not being followed.
Residents are not provided with water.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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 allegations are stated above. During LPA's visit, LPA interviewed ten residents and four staff members.

Residents are threatened while in care - The ten residents who were interviewed had stated had never been threatened by staff members or residents since living in the facility. LPA spoke to four staff members who stated never threatened residents and have not witnessed another staff member or another resident threaten a resident. LPA asked staff members if any residents had reported being threatened by staff or residents. All four staff members stated no. Therefore the allegation is unsubstantied.

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)

Page: 1 of 4

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
02/22/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20210222171452

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):

1
2
3
4
5
6
7
8
9

Residents are not provided food.
Menus are not available.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

LPA Spaeth interviewed ten residents at the facility and asked if residents receive an adequate supply of food. Six of the ten residents stated no. All six residents stated there have been times when facility has ran out of food, residents have asked for additional servings but were told second helpings were not available. LPA asked if been offered additional food such as soup or sandwich. Three residents stated had asked for the additional option but was told there was no additional food available. Therefore, this allegation is substantiated. LPA Spaeth requested to observe the posting of the facility menu. At 11:45 am, Administrator Designee, Tannya Quezada stated the menu was not posted. Therefore this allegation is substantiated. Under Title 22 General Regulations, the following citation was issued and recorded on LIC 809D.
Exit interview was conducted, appeal rights discussed and LPA confirmed a copy of the report will be emailed to Administrator Designee; email address is avrmanorintake@gmail.com.

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: 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)

Page: 2 of 4

Control Number 31-AS-20210222171452

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: 08/27/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/07/2021 Section Cited CCR 87555(b)(6)	1 2 3 4 5 6 7	87555(b)(6) The following food service requirements shall apply: In facilities for sixteen (16) persons or more, menus shall be written at least one week in advance and copies of the menus.. shall be dated & on file for at least 30 days.	1 2 3 4 5 6 7	Administrator Designee will make sure the daily menu will be available for residents to receive a copy.
	8 9 10 11 12 13 14	This requirement was not met based upon: LPA toured the facility and did not see the menu posted or copies available for residents. Administrator Designee, Tanya Quezada confirmed a copy was not posted & not given to residents.	8 9 10 11 12 13 14
Type B 09/07/2021 Section Cited HSC 87555(a)	1 2 3 4 5 6 7	87555(a) The total daily diet shall be of the quality and in the quantity necessary to meet the needs of the residents & shall meet the Recommended Dietary Allowances of the Food & Nutrition Board of the National Research Council.	1 2 3 4 5 6 7	Kitchen staff will be required to prep soup and sandwich items prior to the lunch and dinner meals.
	8 9 10 11 12 13 14	This requiement was not met based upon: LPA Spaeth interviewed ten residents regarding quantity of food received. Six of the ten stated facility had run out of food and did not offer aadditional food choices. to the residents.	8 9 10 11 12 13 14

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: 08/27/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 31-AS-20210222171452

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: 08/27/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Facility is not maintaining a comfortable temperature for residents.- LPA Spaeth interviewed ten residents and asked if facility was maintaining a comfortable temperature throughout the facility. All ten residents stated yes. Four staff members were also interviewed and asked if residents had stated the facility temperature was not comfortable. The staff members stated no. This allegation is unsubstantiated.

Residents' dietary plan is not being followed. LPA Spaeth interviewed resident regarding dietary need and resident stated facility does provide dietary requirements. Resident stated kitchen staff are helpful and the resident has no complaints. LPA Spaeth interviewed Administrator Designee, Tannya Quezada as of August 26, 2021 who stated kitchen staff prepare specific meals for residents who have dietary requirements. The kitchen staff wrap the plate of food with plastic before serving, place a sticker with resident's name so staff who serve food will know the special meal is for a specific resident. This allegation is unsubstantiated.

Residents are not provided with water.- On August 27, 2021, LPA observed there are three water machines available on the first floor for residents to access water. At 10:00 am LPA observed both machines were working and LPA saw two residents filling drinking cups. LPA also observed a water fountain on the second floor available for residents' use. This allegation is unsubstantiated.

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

LIC9099 (FAS) - (06/04)

Page: 4 of 4