197610032-7-13-2022-31-AS-CHAS-CHFQA6-20220819115926

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 07/07/2022
Date Signed: 07/13/2022 11:42:42 AM

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
09/21/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20210921124112

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: 108	DATE:	07/07/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:			TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility did not notify resident’s authorized representative of resident’s move.

INVESTIGATION FINDINGS:

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LPA Spaeth conducted an unannounced visit regarding the complaint. Upon arrival, LPA's temperature was recorded and COVID questions were completed. LPA explained the purpose of the visit was to investigate a copmlaint which states facility did not notify resident's authorized representative of resident's move.

LPA reviewed resident records from 11:15 am until 11:50 am. LPA Spaeth toured the facility from 12:00 noon until 12:20 pm but did not observe any health and safety issues. LPA received copies of the resident records(R1) mentioned in the complaint. LPA interviewed the Licensee, Administrator, previous Administrator and hospice agency from 12:30 pm until 2:20 pm. LPA received documentation via email from the hospice agency at 2:24 pm

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: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

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-20210921124112

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: 07/07/2022

NARRATIVE

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During LPA's interviewof the hospice agency, the office manager stated tried to reach the Conservator to inform of the need for hospice services but was unsuccessful. Since the agency was unable to speak to the Conservator, the agency received authorization from R1's physician and LPA obtained documentation from a second physician stating R1 should be on Hospice.. LPA obtained the documentation of the hospice agency Also, the previous Administrator and Licensee were interviewed and confirmed always informed the Conservator of any changes in R1's health or of R1's needs.

The Administrator confirmed received a letter from the Conservator dated September 17, 2021 which states the resident was approved by Conservator to move to another facility location. LPA obtained a copy of the letter.

Therefore the allegation, Facility did not notify resident’s authorized representative of resident’s move is unsubstantiated. Exit interview conducted and appeal rights discussed. A copy of the 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: 07/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2022

LIC9099 (FAS) - (06/04)

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