197610032-4-15-2024-31-AS-EMIR-D53PBV-20240508111058

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 04/15/2024
Date Signed: 04/15/2024 03:16:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
02/13/2023 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20230213132242

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: 130	DATE:	04/15/2024
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Staff inappropriately touched resident in care.

INVESTIGATION FINDINGS:

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At 10:45 a.m. Licensing Program Analyst (LPA) Evelin Rios conducted a subsequent unannounced complaint visit to continue investigation on the allegation above. LPA met with, Administrator Jessica Pelaya and explained the reason for today's visit.

An entrance interview was conducted with the administrator Jessica at 10:45 a.m. and a review of previously obtained records from LPA's visit on 02/22/2023 were discussed. On todays visit LPA reviewed and obtained copies of the facility's current resident roster, shower schedule, and three (3) staff LIC501s (job applications). At 11:35 a.m., LPA along with Jessica, conducted a physical plant tour of the facility to ensure the health and safety of the residents in care. While conducting physical plant tour LPA interviewed four (4) of the seven (7) residents previously interviewed on 02/22/2023 that are still in the facility and later interviewed five (5) more residents currently requiring assistance with showers.
(Continued to LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

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-20230213132242

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY	FACILITY NUMBER: 197610032
	VISIT DATE: 04/15/2024

NARRATIVE

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(LIC9099-C)
Allegation: Staff inappropriately touched resident in care. To investigate the allegation LPAs Evelin Rios and Melissa Spaeth conducted an initial visit on 02/22/2023. On initial visit LPAs obtained copies of facility's resident roster, employee roster, shower schedule, employee schedules, resident #1's (R1's) facility record, police report Information involving R1, unusual incident/injury report related to police report, and hospital discharge paper work for R1. On 02/22/2023 LPAs interviewed the administrator Jessica, interviewed seven (7) residents, and interviewed two (2) staff that assist resident's with showers. LPA review of records and interview with the administrator on 04/15/2024 revealed no staff fitting a description of the alleged perpetrator assisted residents with showers then and now. Interview with seven (7) residents on the initial visit on 02/22/2023 and interviews with residents today do not corroborate the allegation revealing, never being inappropriately touched by staff or witnessing or hearing about staff inappropriately touching a resident. Interviews with staff on 02/22/2023 do not corroborate the allegation. Interview with the administrator on 02/22/2023 and today deny the allegation. Interview with administrator on 04/15/2024 revealed R1 only required "stand by assistance" when showering due to their fall risk status. Interview with administrator and staff revealed R1 would shower in their own bathroom or shower in the larger facility bathroom where in either scenario, staff would stand by the shower with the curtain closed reassuring R1 someone was their to assist if R1 had a fall. LPA search of male staff names that assist residents with showers revealed there is no previous allegation similar to this complaint. LPA interview with R1's conservator revealed R1 may make false accusations if they feel they are not getting their way. Based on interviews, there is not enough evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated at this time.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin Rios	TELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2024

LIC9099 (FAS) - (06/04)

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