197610032-7-29-2021-31-AS-CHAS-CJS59Z-20220930194622

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 07/29/2021
Date Signed: 07/29/2021 05:11:45 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
07/02/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20210702165006

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: 111	DATE:	07/29/2021
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Tannya Quezada		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not assist resident with transporting from the hospital to the facility

INVESTIGATION FINDINGS:

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LPA Spaeth conducted a complaint investigation and arrived at the facility at 1:15 pm. Upon arriving, LPA was greeted by staff member at the office entrance. LPA's temperature was recorded and LPA answered the COVID questions. Staff member then called Administrator Designee, Tannya Quezada and LPA was greeted by Administrator Designee.

LPA stated the purpose of the visit is the investigation of the allegation, staff did not assist resident with transporting from the hospital to the facility. Complainant stated picked up resident at the hospital and requested staff to provide a wheelchair at the front entrance for resident. Complainant stated the wheelchair was not available upon arrival to the facility.

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: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

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-20210702165006

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: 07/29/2021

NARRATIVE

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LPA Spaeth interviewed Administrator Designee and Caregiver Rachel Ramos who both stated caregiver did provide a wheelchair within a timely manner on July 2, 2021. Both Administrator and Caregiver stated the request by Complainant was completed within fifteen to 20 minutes. Caregiver confirmed with LPA Spaeth that Caregiver did take the wheelchair to the front entrance for R1's use.

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: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 07/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021

LIC9099 (FAS) - (06/04)

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