197610032-6-13-2022-31-AS-CHAS-CGCUT4-20220715155119

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 06/13/2022
Date Signed: 06/13/2022 12:00:44 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
06/10/2022 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20220610130139

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: 107	DATE:	06/13/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Resident sustained wounds while in care

Staff did not seek any medical attention for resident in care

INVESTIGATION FINDINGS:

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LPA Spaeth arrived at the facility and was greeted by receptionist. LPA's temperature was recorded and LPA answered the COVID questions at the sign in station. LPA was greeted by the Administrator and LPA stated the purpose of the visit was to investigate the complaint which states resident sustained wounds while in care and staff did not seek any medical attention for resident in care.

LPA interviewed resident from 9:15 am until 9:40 am and interviewed two staff members from 9:45 am until 10:30 am. LPA conducted a tour of the facility from 10:30 am until 10:45 am and did not obsevve any health or safety issues at the facility. LPA reviewed resident's file from 10:45 until 11:00 am and obtained a copy of related documentation from resident's file.

Resident sustained wounds while in care - Reporting party stated resident had two open wounds on R1’s body. LPA interviewed resident (R1) mentioned in the complaint who stated did not have any open wounds and has not had any wounds for the entire time been living in the facility. At 9:40 am, LPA observed there

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: 06/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022

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-20220610130139

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: 06/13/2022

NARRATIVE

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were no wounds on R1’s arms. LPA asked if R1 had any other open wounds on body and R1 again stated had no wounds on R1’s body. LPA interviewed two staff members who stated have not observed open wounds on R1 and also stated R1 had never reported had open wounds. Therefore, this allegation is unsubstantiated.

Staff did not seek any medical attention for resident in care – Reporting party stated R1 has an infection and staff did not seek medical care for R1. LPA interviewed R1 at 9:15 am and asked if R1 had an infection. R1 stated had infection two months ago but staff contacted physician who provided an antibiotic and stated the infection was gone. LPA interviewed Administrator who stated R1 had reported infection, physician was immediately contacted, and antibiotic was provided to resident. LPA received a copy of the Medication Administration and Centrally Stored Medication Record for R1 which confirmed R1 was given the medication and that R1 did take the medication..

LPA asked if R1 had received the medical supplies needed for R1’s care. R1 stated yes and stated asked Administrator for the supplies and received from Administrator on Sunday, June 12, 2022. R1 showed LPA the supplies at 9:25 am. This allegation is also unsubstantiated.

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

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2022

LIC9099 (FAS) - (06/04)

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