197610442-10-31-2025-31-AS-TAGD-DP9USS-20251211145049

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 10/31/2025
Date Signed: 10/31/2025 02:14:17 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
10/27/2025 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20251027113254

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: 167	DATE:	10/31/2025
		UNANNOUNCED	TIME BEGAN:	09:07 AM
MET WITH:	Stephanie Oden - Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility did not ensure to have a sufficient amount of food to provide for the residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Administrator Stephanie Oden and explained the reason for the visit.

LPA conducted a physical plant tour at 9:34 AM, requested copies of facility documents at 10:12 AM and interviewed staff and residents between 10:30 AM to 1:30 PM. Regarding the allegation that Facility did not ensure to have a sufficient amount of food to provide for the residents, it was alleged that Resident #1 (R1) was not provided with breakfast and the facility failed to provide lunch or dinner due to the supply issue. LPA's observation during the physical plant tour at 9:34 AM revealed that the facility has sufficient stock of perishable food for two (2) days and non-perishable for seven (7) days. LPA's interview with the Culinary Director today at around 10:44 AM revealed that the food is being delivered twice a week on Mondays and Thursdays and admitted that there were some delays due to logistical issues with the Food company but it only happened about twice since the culinary director's tenure of about six (6) months.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025

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-20251027113254

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 VALE ASSISTED LIVING	FACILITY NUMBER: 197610442
	VISIT DATE: 10/31/2025

NARRATIVE

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(continued from LIC 9099)

LPA's interview with four (4) dietary staff today between 10:30 AM to 1:30 PM revealed that there was no time that they missed any meals (breakfast, lunch and dinner) at any time as they always have sufficient supply of foods, from cereal for breakfast to whatever is on the menu for lunch and/or dinner. Further interview also revealed that R1 goes to the day program for most of the morning and had to leave early so R1 only eat cereal with milk and coffee during the times R1 eat breakfast at the facility. R1 eats breakfast most of the time at the Day Program. LPA's record review of the facility menu and observation during visit revealed that the facility served what was written in the menu and had an alternative food in case a resident did not like what is being served at this time such as Peanut butter and Jam, Ham and Cheese and Tuna sandwich, in stock for any resident. LPA also observed that the facility is serving Hot dog sandwich, Quesadilla and Grilled Cheese sandwich during lunch at the request of some residents. LPA's interview with seventeen (17) residents or more than 10% of the current census revealed that seventeen (17) out of seventeen (17) residents interviewed stated that the food is sufficient and they never missed any meal (breakfast, lunch and dinner) at any time while staying at the facility.

Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Jose Gary Tan
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025

LIC9099 (FAS) - (06/04)

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