197610032-6-19-2024-31-AS-NGID-D73VNQ-20240711163532

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 06/19/2024
Date Signed: 06/19/2024 11:28:14 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
08/04/2022 and conducted by Evaluator Lorena Casillas

COMPLAINT CONTROL NUMBER: 31-AS-20220804154108

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:	DATE:	06/19/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Jessica Pelaya		TIME COMPLETED:	11:45 AM

ALLEGATION(S):

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Facility did not notify responsible party of resident's death.
Facility refused to provide resident's personal belongings to responsible party.

INVESTIGATION FINDINGS:

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On 06/19/2024 at 09:30 am Licensing Program Analyst (LPA), Lorena Casillas conducted an unannounced complaint visit to investigate the above stated allegations. LPA met with Administrator Jessica Pelaya and explained the reason for the visit.

At 10:00 am pending interview was made. At 10:30 AM LPA Casillas conducted a physical plant tour. LPA collected Resident #1's (R1's) death certificate. On 6/17/2024 LPA had previously requested resident roster, Liability Insurance, Bond, LIC 500 and copies of pertinent information relevant to the investigation including but not limited to resident records, police reports, and any other information pertaining to the investigation, therefore these items were not collected on this visit.

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

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-20220804154108

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY	FACILITY NUMBER: 197610032
	VISIT DATE: 06/19/2024

NARRATIVE

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On 11/08/2021 LPA Spaeth conducted an investigation for complaint # 31-AS-20211108150903. Two allegations are the same as the allegations in this complaint. LPA Casillas compared notes and conducted interviews to verify the information obtained in the previous complaint. This visit is a follow up to make sure that nothing was missed from the first investigation.

Allegation #1 Facility did not notify responsible party of resident's death.

It is alleged that facility did not notify responsible party of resident’s death. Regarding this allegation it is reported that Resident #1’s (R1) family was not notified of R1’s death when it happened on 07/06/2021, but instead was notified a week later. LPA interviewed the Administrator, and it was confirmed that the previous Administrator and the Los Angeles Sheriff's Department had tried to reach the family member in a timely manner, however the family member returned calls several days after the death of R1. Furthermore, in an interview conducted by LPA Spaeth it was discovered that R1’s grandson, admitted to getting the days confused and thought that a message left was on 07/12/2021 and not 07/06/2021. Based on interviews and record reviews this allegation is deemed unsubstantiated at this time.

Allegation #2 Facility refused to provide resident's personal belongings to responsible party.

It is alleged that facility refused to provide residents’ personal belongings to responsible party. Regarding this allegation it is reported that the facility is failing to return R1’s belongings after their death. LPA confirmed with Administrator that residents' possessions were securely stored in the donation room for over (2) two years from R1's death. R1’s family members were made aware that items were available for pick up however, LPA was advised that R1's family members failed to arrange for delivery or pick up of R1’s possessions after facility staff attempted to get in contact with family numerous times. Furthermore, Administrator states that they had a conversation with R1's relative and they were supposed to rent a U-Haul and pick up R1's property but never showed up. Based on record reviews and interviews this allegation is deemed unsubstantiated at this time.

No citations issued. Exit interview was conducted. A copy of the report was provided to Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena Casillas	TELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:	DATE: 06/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2024

LIC9099 (FAS) - (06/04)

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