197610032-12-30-2022-31-AS-MVAO-CN6UH2-20230117143514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 12/30/2022
Date Signed: 12/30/2022 01:56:57 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
11/22/2022 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20221122152507

FACILITY NAME:	LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY		FACILITY NUMBER:	197610032
ADMINISTRATOR:	JESSICA PELAYA		FACILITY TYPE:	740
ADDRESS:	44523 15TH STREET WEST		TELEPHONE:	(661) 941-4578
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	157	CENSUS: 112	DATE:	12/30/2022
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Resident was able elope from the facility without staff's knowledge
Staff did not meet resident's hygiene needs

INVESTIGATION FINDINGS:

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LPA Spaeth conducted an unannounced visit and was greeted by Receptionist. LPA observed the staff wearing a mask upon entering the facility. LPA was greeted by Administrator at 9:20 am and LPA stated the purpose of the visit was regarding a complaint which states resident was able to elope from the facility without staff's knowledge and staff did not meet resident's hygiene needs.

LPA interviewed a resident at 8:50 until 9:10 am and interviewed the caregiver manager at 9:45 am until 10:00 am. LPA and Administrator toured the facility from 10:30 am until 10:25 am. LPA observed a two day supply of perishable foods and a seven day supply of non-perishable foods. LPA also observed an adequate supply of PPE items and personal hygiene items for the residents. LPA did not observe any health or safety issues.
LPA interviewed five caregivers from 12:15 pm until 12:45 pm.

In regard to the allegation, resident was able to elope from the facility without staff's knowledge was unsbustantiated. LPA Spaeth received a copy Resident's Physician's Report for Residential Care

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: 12/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2022

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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Control Number 31-AS-20221122152507

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: 12/30/2022

NARRATIVE

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Facilities for the Elderly report which states R1 is able to leave the facility unassisted. LPA interviewed R1 and confirmed with R1 that R1 did sign out when left the facility on 11/18/2022. Also LPA interviewed the receptionist who stated R1 always signs out.

In regard to the allegation, staff did not meet resident's hygiene needs is also unsubstantiated. R1's Physician's Report for Residential Care Facilities for the Elderly states R1 is able to bathe self and able to dress/groom self. LPA interviewed the Caregiver manager and five caregivers who stated all verbally encourage R1 each day to take a shower and to change clothing. However caregivers all stated R1 refuses to shower and change clothing many times each week.

Exit interview was completed and a copy of the signed report was given 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: 12/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2022

LIC9099 (FAS) - (06/04)

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