197610032-11-22-2022-31-AS-RRAZ-CLLLZM-20221128081207

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 12/16/2021
Date Signed: 11/22/2022 10:05:28 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
10/20/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20211020162016

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:	12/16/2021
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff over medicated resident
Resident not accorded dignity in relationships with staff
Staff did not clean a resident's room from an odor
Staff are not allowing resident to leave or depart the facility at any time
Staff are not allowing resident access to personal items

INVESTIGATION FINDINGS:

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LPA Spaeth completed an unannounced visit and met with Administrator, Jessica Pelaya. LPA explained the purpose of the visit was to conduct the final visit regarding the allegations above. LPA amended 9099 report of 12/16/2021 adding additional interviews conducted by LPA Spaeth as of today, 11/21/2022.

Staff over medicated resident - LPA Spaeth interviewed the medical technician, Araceli F. (S1) at 3:30 pm on 12/08/2021 who stated R1 was not prescribed the medication Trazodone. LPA received a copy of R1’s centrally stored medication record and observed the medication was not on the list. S1 stated during the month of October, R1 refused to take medications. At 3:40 pm, LPA obtained a copy of the medication report and LPA observed the letter R in each designated day which indicates refusal. The allegation, staff over medicated resident is unsubstantiated.

Resident not accorded dignity in relationships with staff - LPA Spaeth interviewed Ernesto G. med tech who was mentioned in the complaint and med tech stated did not snicker at the resident. The med tech stated R1

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: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

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-20211020162016

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: 12/16/2021

NARRATIVE

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has refused medications for over a month. Also, Med tech did not witness R1 trying to locate the elevator and did not appear dizzy. Also, LPA interviewed nine residents who stated all staff treated residents with dignity & have never snickered at residents. The allegation, resident not accorded dignity in relationships is unsubstantiated.

Staff did not clean a resident's room from an odor - LPA Spaeth spoke to cleaning staff member S1 today at 12:20 pm and asked if R1 had stated room had an odor. S1 stated the carpet was cleaned by maintenance staff member and S1 mopped the bathroom two times. S1 stated after the carpet was clean, there was no odor. LPA interviewed nine residents who stated rooms are always cleaned and never smell odor in room. Therefore, the allegation, staff did not clean a resident’s room from an odor is unsubstantiated.

Staff are not allowing resident to leave or depart the facility at any time – LPA Spaeth interviewed Administrator on 12/15/2021. Administrator stated witnessed R1 leaving the facility on various occasions. LPA Spaeth reviewed resident’s records and observed the physician’s assessment stated resident could leave the facility on own. Also, LPA observed the residents’ sign out sheet which indicates R1 left the facility on November 7, 2021. Therefore, the allegation, staff are not allowing resident to leave or depart the facility at any time is unsubstantiated.

Staff are not allowing resident access to personal items – LPA Spaeth interviewed Administrator on 12/15/2021. Administrator stated R1 had a out of town Post office box and a Staff member drove R1 to the local post office to do a change of address. Administrator stated R1 received mail at the facility. Also, LPA interviewed nine residents who stated there has not been any issues with receiving mail and staff have not with held personal mail. Therefore, this allegation staff not allowing resident access to personal items is unsubstantiated.

Exit interview conducted, appeal rights discussed, and a copy of the report was submitted to the Administrator.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC9099 (FAS) - (06/04)

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