197610032-4-27-2023-31-AS-NMAN-CRFSQF-20230502140439

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 04/26/2023
Date Signed: 04/27/2023 02:18:32 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
09/07/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20210907144133

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: 114	DATE:	04/26/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident was not provided medications as prescribed.
Residents logs are being falsified.
Resident not being provided adequate service.

INVESTIGATION FINDINGS:

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On 4/26/2023, Licensing Program Analyst (LPA) Melissa Spaeth arrived at the facility to conduct an unannounced complaint investigation. Upon arrival, LPA was greeted by the Administrator. LPA explained the purpose of the visit was to complete the investigation of the allegations, resident was no provided medicaitons as prescribed, resident logs are being falsified and resident not being provided adquate service.

LPA reviewed resident (S1) records at 10:30 am until 10:45 am. LPA interviewed Administrator from 10:45 am until 11:15 am. LPA also interviewed the med tech supervisor, observed medication distribution for thirteen (13) residents, and reviewed residents' medication logs at 11: 30 am until 12:30 pm. LPA interviewed twelve residents from 12:30 pm until 1:30 pm.

Resident was not provided medications as prescribed - LPA interviewed the reporting party who stated Resident (1) did not receive three medications on 8/01/2023 to 8/ 24/2023. LPA interviewed the medical tech supervisor who stated received instruction from the pharmacy on 7/02/2021 stating the three medications

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: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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-20210907144133

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: 04/26/2023

NARRATIVE

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should be discontinued. Also, the medical tech supervisor confirmed one of the three prescriptions were prescribed again on 8/24/2023. The medical tech stated R1's doctor contacts the pharmacy directly regarding any medication changes for R1. LPA also received copies of the pharmacy instructions regarding R1's medication. The medical tech supervisor stated R1's doctor sent prescription changes directly to the pharmacy, not to the facility. LPA interviewed R1 on 9/15/2022; R1 stated could not remember if missed medications during the month of August, 2021.

Resident logs are being falsified - LPA interviewed the medical tech supervisor (S1), Administrator and Licensee. The Licensee stated S1 did not ask permissions to falsify R1' medication logs and Licensee did not give R1 permission to falsify the medication log. The Administrator stated the Licensee and S1 never stated to Administrator that S1's medications logs were changed. LPA observed S1 distribute medications to thirteen residents. LPA also reviewed thirteen resident medication logs and did not observe falsified records. Therefore this allegation is unsubstantiated.

Resident not being provided adequate service - LPA interviewed R1's roommate (R2). R2 stated staff assist with medication but R2 stated is independent and does not require any additional services from the staff. R2 also stated does not have any issues regarding the care provided and R2 stated did not tell roommate that staff are not providing the care R2 needs. LPA also interviewed thirteen residents who stated receive adequate care such as changing, assistance with showering and other services from the staff. All thirteen residents stated do not have any issues regarding care provided by the caregivers. Therefore, the allegation is unsubstantiated.

Exit interview conducted 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: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC9099 (FAS) - (06/04)

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