197610442-8-15-2025-31-AS-NMAN-DPFVM5-20251217153259

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 08/15/2025
Date Signed: 08/15/2025 04:21:23 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
08/13/2025 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250813113546

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: 169	DATE:	08/15/2025
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Executive Director, Stephanie Oden		TIME COMPLETED:	10:39 AM

ALLEGATION(S):

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Staff forced resident in care to shower

INVESTIGATION FINDINGS:

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At 10:15a.m. Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced initial visit for the above noted allegation. LPA met with the Executive Director and explained the reason for the visit.

At about 10:30a.m. LPA requests and receive staff and resident rosters. At approximately 10:40a.m. LPA and Administrator Coordinator conducted a physical plant tour, interviewed randomly selected seventeen (17) residents including resident (R1) throughout the facility. In addition, at 11:20a.m., LPA requested copies of pertinent documents relevant to the investigation. LPA also reviewed the documents obtained. LPA interviewed Executive Director, Administrator Coordinator, Wellness Director, Wellness Coordinator and Caregiver that provides care to R1. LPA asked questions relevant to the nature of the complaint.
Staff forcing residents to take showers.
It was alleged that resident (R1) was assaulted when assisted with taking a shower. Concerns were addressed that staff assaulted R1 when assisting with taking a shower. Staff denied assaulting residents
Cont. on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025

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-20250813113546

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: 08/15/2025

NARRATIVE

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Cont. from LIC 9099
when assisting with shower. They revealed that R1 was able to take a shower/bathe themselves they just assist if needed. During today’s interview R1 indicated that staff never assault them when taking a shower. Other residents interviewed during investigation denied being assaulted when taken a shower and had no concerns. Records verify that R1 is able bath/shower themselves. Per review of R1’s shower schedule, R1 was taking showers two (2) times per week and the staff was keeping shower schedule for R1.
Based on observation, interviews, and record review there is no sufficient information to corroborate the allegation. Therefore, allegation deemed to be UNSUBSTANTIATED at this time.

No health and safety hazard is noted during this visit.

Exit interview is conducted and copy of report was provided to Executive Director.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 08/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025

LIC9099 (FAS) - (06/04)

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