197610442-11-12-2025-31-AS-NGID-DQBTZB-20260114141002

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 11/12/2025
Date Signed: 11/12/2025 02:52:51 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
11/06/2025 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20251106103910

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: 166	DATE:	11/12/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Maria Cerventes, Business Office Manager		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Illegal Eviction

INVESTIGATION FINDINGS:

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At 10:00am, Licensing Program Analyst (LPA), Angela Panushkina conducted an initial, unannounced visit in response to the above-mentioned allegation. LPA met with the Business Office Manager and explained the reason for the visit.

At 10:10am, LPA requested resident and staff roster. At 10:15am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement and Eviction Policy relevant to the investigation. At approximately 10:20am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 10:25am – 12:30pm, LPA conducted an interview with the Business Office Manager (BOM), two (2) staff, two (2) MedTechs, one (1) housekeeper, one (1) concierge and sixteen (16) residents.

Continue on LIC909-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2025

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-20251106103910

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: 11/12/2025

NARRATIVE

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Allegation: Illegal Eviction

It was alleged that Resident #1 (R1) was unlawfully evicted. Prior to the visit, LPA reviewed the facility’s complaint history, including complaints control (#28-AS-20230223145614 and #31-AS-20250903125435), which involved R1 with the same allegation. The 1st complaint investigation revealed that R1 allegedly refused to return to the facility following hospitalization, and R1 was reported to have relocated to another facility. Interview with BOM revealed that she started working at this facility since February 2025 and was not aware of R1 and or R1 being unlawfully/illegally evicted. However, during the 2nd complaint investigation BOM was informed that R1 was relocated from this facility over three (3) years ago. Moreover, BOM informed LPA that the last eviction was issued in August 2025 to R2 for non-payment and the facility followed all proper eviction procedures, and there are no current evictions in process or pending. Staff and residents interviewed were unable to identify R1 and had no knowledge of any recent evictions. Sixteen (16) residents interviewed expressed no concerns regarding this allegation. Lastly, LPA conducted review of resident roster and confirmed that R1 is not a current resident at this facility. Based on interviews, record reviews and information gathered, during today’s visit, this allegation is deemed Unsubstantiated at this time.

No deficiency issued during today's visit.
Exit interview conducted and a copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 11/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/12/2025

LIC9099 (FAS) - (06/04)

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