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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197610032
Report Date:
07/12/2021
Date Signed:
07/13/2021 03:38:36 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
07/08/2021
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20210708103731
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:
112
DATE:
07/12/2021
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Tannya Quezada
TIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not seek timely medical care for resident
Staff did not supply resident with a bed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an initial complaint visit regarding the allegation above. LPA met with the administrator and explained the reason for this visit.
Upon entry to the facility LPA conducted a brief physical plant tour to ensure no health and safety issues were present. During the walk through LPA did not notice any health and safety issues.
At approximately 10:30 am LPA conducted an interview with the administrator regarding the allegation. It is alleged that resident # 1(R1) was removed from hospice services and R1's disposable catheter bag was removed also. At approximately 11am LPA conducted an interview with R1 regarding the allegation. R1 stated that without warning he was discharged from hospice and that his hospital bed and disposable catheter bags were taken. R1 stated that he let the facility staff know and that they were able to contact a home health and to bring him some more disposable bags until a new hospice or home health could be found. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/12/2021
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
3
Control Number
31-AS-20210708103731
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:
07/12/2021
NARRATIVE
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32
Staff did not supply resident with a bed
It is alleged that the facility did not supply R1 with a bed after R1's hospital bed was taken by hospice agency without notice. LPA conducted interviews with the administrator and R1. Information from the interviews reveal that R1 was removed from hospice services without proper notice. Hospice agency showed up to the facility and gave R1 one hour notice before taking R1's bed. According to the facility they did not have any notice that R1 was being discharged from hospice and did not have an available hospital bed to give R1. R1 was instead given another bed that same day by facility staff. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.
Exit Interview conducted.
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
07/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
07/12/2021
LIC9099
(FAS) - (06/04)
Page:
3
of
3