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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 07/14/2022
Date Signed: 07/15/2022 10:06:24 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
07/13/2022 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20220713162337
FACILITY NAME:LEISURE GARDEN SENIOR ASSISTED LIVING FACILITYFACILITY NUMBER:
197610032
ADMINISTRATOR:JESSICA PELAYAFACILITY TYPE:
740
ADDRESS:44523 15TH STREET WESTTELEPHONE:
(661) 941-4578
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:157CENSUS: 107DATE:
07/14/2022
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Jessica PelayaTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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9
Staff are not allowing resident to contact their physician.
Staff are refusing to allow resident to take their medication.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Melissa Spaeth conducted an unannounced complaint visit to investigate the allegation above. LPA met with the administrator and explained the reason for this visit.
LPA conducted a brief physical plant tour from 11:30-11:45 am to ensure no immediate health and safety issues were present. LPA did not observe any immediate health and safety issues.
It is alleged that staff are not allowing resident (R1) to contact their physician. LPA conducted interviews with R1 from 11:45 to 12:30 pm regarding this allegation. LPA interviewed facility staff from 12:45 pm until 3:00 pm. Staff interviews revealed that R1 had not asked staff for assistance to speak to R1's physician. Based upon interviews of staff members, this allegation is unsubstantiated.
It is alleged that staff are refusing to allow R1 to take medication. LPA interviewed R1 and R1 stated did not receive PRN medication on 7/12/2022 during evening hours. LPA reviewed medication records which reveals R1 did receive PRN medication. Based upon LPA's interview of med tech staff and caregivers who worked that day, R1 did receive the medication. Therefore this allegation is unsubstantiated.
Exit interview conducted, appeal rights discussed, and a copy of the report was given to Administrator..
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa SpaethTELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:

DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022
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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