197610442-3-12-2025-31-AS-TAGD-DFCRPL-20250402131208

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 03/12/2025
Date Signed: 03/12/2025 01:03:51 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.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
03/07/2025 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250307125306

FACILITY NAME:	LEISURE VALE ASSISTED LIVING		FACILITY NUMBER:	197610442
ADMINISTRATOR:	ANGELA SMITH		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS STREET		TELEPHONE:	(818) 244-2323
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 172	DATE:	03/12/2025
		UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Angela Smith, Administrator		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility elevator is in disrepair

INVESTIGATION FINDINGS:

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On 03/12/25, at 9:05am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Angela Smith, Administrator. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 03/12/25, LPA Saucedo asked for the census, staff, and resident rosters. On 03/12/25, LPA Saucedo conducted a physical tour and interviewed staff and residents.

LIC 9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

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-20250307125306

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 VALE ASSISTED LIVING	FACILITY NUMBER: 197610442
	VISIT DATE: 03/12/2025

NARRATIVE

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Regarding the allegation: Facility elevator is in disrepair. It is being alleged that the elevator was not working and there is residents that use wheelchairs on the third floor. During LPA's physical tour, LPA observed the elevator to be working. LPA toured the second and third floor and conducted seventeen (17) interviews on the second and third floor that confirmed the elevator has been working and that they do not use wheelchairs. LPA also observed residents on the second and third floor not using any wheelchairs. LPA interviewed three (3) staff that confirmed the elevator has been working. Therefore, based on the LPA's observations, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.
An exit interview was conducted, no citation(s) were issued and a copy of this report was given to the administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 03/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025

LIC9099 (FAS) - (06/04)

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