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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 03/05/2025
Date Signed: 03/05/2025 02:06:45 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
02/28/2025 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20250228131814
FACILITY NAME:LEISURE VALE ASSISTED LIVINGFACILITY NUMBER:
197610442
ADMINISTRATOR:ANGELA SMITHFACILITY TYPE:
740
ADDRESS:413 E. CYPRESS STREETTELEPHONE:
(818) 244-2323
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:199CENSUS: 173DATE:
03/05/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Angela SmithTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not follow up with resident's medical coverage.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abeye Duguma conducted an initial complaint visit to the facility to investigate the above allegations. LPAs met with Executive Director, Angela Smith, and explained the reason for the visit.

--- Staff did not follow up with resident's medical coverage.

It was alleged that facility did not assist with Resident #1's (R1) HMO insurance coverage. To investigate the allegation, LPA interviewed three (03) residents from around 11:00a.m. to 11:45a.m. and two (02) staff from around 11:45a.m. to 12:30p.m. During interviews with residents, R1 stated they made a mistake, and it was all a mix up, the issue was resolved immediately, they got the care they needed and wishes to remove the complaint. All other residents stated facility assists with medical appointments and transportation and are not experiencing any issues with getting assistance.
(cont. on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20250228131814
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 VALE ASSISTED LIVING
FACILITY NUMBER: 197610442
VISIT DATE: 03/05/2025
NARRATIVE
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During interviews with staff, Staff #1 (S1) stated they assist residents with scheduling doctor’s appointments and transportation. S1 added that, as a courtesy, staff assist residents with applying for and managing their insurance. Staff also encourage residents to follow-up with appointments and checkups. Staff #2 (S2) stated resident does not have HMO, rather resident has MediCal-Medicare (Medi-Medi), and when at the doctor’s appointment, R1 presented their expired HMO card, and the doctor rejected them. S2 added they rescheduled the appointment for two (02) days after R1’s error and R1 has since received treatment.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards were noted during the visit.

Exit interview was conducted and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2