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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 10/20/2022
Date Signed: 10/21/2022 11:28:04 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
12/21/2021 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20211221090412
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: 115DATE:
10/20/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Jessica Pelaya TIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Facility did not seek medical attention in a timely manner.
Resident has lice.
Resident's hygiene needs are not being met.
INVESTIGATION FINDINGS:
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LPA Spaeth conducted an unannounced visit and was greeted by Administrator. LPA stated the purpose of the visit was to investigate allegations, facility did not seek medical attention in a timely manner, resident has lice, and resident's hygiene needs are not being met.

LPA conducted a tour of the facility from 10:30 am until 10:50 am and did not observe any health or safety issues on 12/22/2021. LPA interviewed twelve residents, three staff members, the Administrator, and the Administrator Designee on 12/22/2021.

Based upon LPA's staff inteviews, staff stated 911 was immediately called when R1 stated was feeling weak and needed medical attention. Residents' interveiws revealed that staff were attentiive to residents' needs to see a doctor or to call 911. Also staff reported R1 did not state to staff needed to see a doctor. However, staff did stated called 911 during the month of January, 2021 when R1 did state was feeling weak. Therefore the allegation, facility did not seek medical attention in a timely manner is unsbustantiated.
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: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
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 2
Control Number 31-AS-20211221090412
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: 10/20/2022
NARRATIVE
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During the staff members' interviews, it was reported to LPA that resident (R1) refused to be showered for over two months. Also LPA interviewed R1's family member who confirmed R1 did refuse to be showered. Also, staff members had stated R1 would not allow staff to assist with any type of hygiene assistance, so staff were not aware R1 had lice. Staff members stated R1 never complained had any health issues or pain. Based upon LPA's interviews of staff members, the allegations Resident has lice and resident's hygiene needs are not being met are unsubstantiated.

Exit interview conducted, appeal rights discussed, and a copy of the report was given to Administrator.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa SpaethTELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2