197610032-3-20-2024-31-AS-TAGD-D45SR8-20240408140553

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 09/15/2023
Date Signed: 03/20/2024 03:48:26 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
11/30/2022 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20221130114717

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: 110	DATE:	09/15/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff do not allow resident to leave the facility
Facility staff did not ensure resident’s prescription was refilled in a timely manner
Facility staff did not seek medical attention in a timely manner
Resident is not receiving mail from facility staff.

INVESTIGATION FINDINGS:

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This is an amendment to correct clerical errors observed in the initial report. The findings remain the same.

On 9/15/2023 Licensing Program Analyst (LPA) Melissa Spaeth and LPA Lorena Casillas conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth was met by Jessica Pelaya, Administrator. LPA explained the purpose of this visit was to deliver findings for this complaint.
The investigation consisted of the following: On 6/06/2023, LPA Spaeth conducted a 10-day visit, toured the physical plant, and reviewed and requested residents’ documents. LPA Spaeth requested the following documents: 1) resident roster, 2) R1’s physician report and appraisal/needs and services plan. All documents were received at the time of visit. LPA Spaeth conducted resident and staff interviews. On 8/04/2023, LPA Spaeth conducted a visit and requested the following documents: 3) R1’s hospital records. LPA interviewed additional residents.
Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

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-20221130114717

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY	FACILITY NUMBER: 197610032
	VISIT DATE: 09/15/2023

NARRATIVE

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This is an amendment to correct clerical errors observed in the initial report. The findings remain the same.

The investigation revealed the following: Regarding the allegation… Facility staff do not allow resident to leave the facility. It is being alleged that staff do not allow the resident to leave without a staff member escorting them. LPA Spaeth interviewed 10 out of 44 staff members in total who stated they have never refused to allow a resident to leave the facility and have never refused to accompany a resident when resident wanted to leave the facility. LPA interviewed 13 out of 110 residents. R13 refused to answer interview questions. 12 residents interviewed unanimously denied the allegation. The residents all confirmed they are allowed to leave the facility. LPA Spaeth reviewed a physician’s report for R13 that states they would benefit from having supervision while in the community. R13’s physician report was later updated to reflect they no longer needed support from the facility while in the community on 3/31/2023.

Regarding the allegation, Facility staff did not ensure resident’s prescription was refilled in a timely manner. It is being alleged that the resident’s prescription was not refilled. The Med Tech Supervisor confirmed ordering resident medications in a timely manner. LPA Spaeth reviewed residents Medication Administration Record (MAR) and observed the inhaler as a PRN. The Med Tech Supervisor also stated the prescribed inhaler is available for residents’ use. LPA also observed the inhaler in the med cart for R13. 10 staff members interviewed confirmed residents have never complained about their prescribed medications not being available. 12 residents were interviewed and stated medications were refilled in a timely manner.

Regarding the allegation, Facility staff did not seek medical attention in a timely manner. It is being alleged that a resident had an injured hand, but facility staff failed to take the resident to the hospital. 12 residents were interviewed and stated staff have immediately arranged doctor’s appointments when requested, have escorted residents to the hospital, and have called 911 if there is a medical emergency. 10 staff members interviewed confirmed arrangement of doctor’s appointments, escorting residents to the hospital, and immediately contacting 911 when needed.
Regarding the allegation, Resident is not receiving mail from facility staff. It is being alleged that mail was sent to a resident, but staff failed to give mail to the resident. Twelve (12) residents confirmed receiving their mail in a timely manner. 10 staff members also confirmed residents are receiving their personal mail.

Based on LPA’s record review and interviews conducted the allegations above are unsubstantiated.
An exit interview was conducted, and a copy of the report was given.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2023

LIC9099 (FAS) - (06/04)

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