197610032-10-24-2022-31-AS-MVAO-CWPSGS-20231017135220

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 10/20/2022
Date Signed: 10/24/2022 09:09:09 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
09/09/2021 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20210909151146

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:	DATE:	10/20/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:			TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff not providing a safe environment for resident.
Facility witholding PNI funds

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, staff not providing a safe environment for resident, and facility withholding PNI funds. LPA conducted a tour of the facility from 10:30 am until 10:50 am and did not observe any health or safety issues.
LPA interviewed three staff members, the Administrator, and the Administrator Designee on 12/22/2021. Caregivers, Administrator and Administrator Designee stated always remind residents to keep room doors locked. A caregiver observed R1 would not lock door to room but Caregiver would continue to remind R1. R1 stated to Caregiver did not want to lock the door. Therefore, the allegation is unsubstantiated.The allegation facility witholding PNI funds is unsubstantiated. During LPA's unannounced visit on 9/10/2021 LPA witnessed Administrator Designee gave R1's PNI money. LPA asked R1 if receipt of PNI money was current and R1 stated yes.
Exit interview conducted, appeal rights discussed, and a copy of the report was given to Administrator.

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: 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)

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