197610442-5-29-2024-31-AS-NMAN-DC2NZ5-20241217095346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 05/29/2024
Date Signed: 05/29/2024 04:11:13 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
05/28/2024 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20240528164626

FACILITY NAME:	LEISURE GROVE, LLC		FACILITY NUMBER:	197610442
ADMINISTRATOR:	MAYA MNOYAN		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS STREET		TELEPHONE:	(818) 244-2323
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 154	DATE:	05/29/2024
		UNANNOUNCED	TIME BEGAN:	12:46 PM
MET WITH:	Brandy Rangel, Assistant Administrator		TIME COMPLETED:	04:07 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Lack of supervision resulting in resident being assaulted by another resident.

Staff did not provide a safe environment for resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegations. LPA met with Assistant Administrator Brandy Rangel and explained the reason for the visit.

It was reported that due to lack of supervision residents assaulted each other. It was alleged that Resident #1 (R1) was punched and pushed by Resident #2. As a result, R1 sustained a broken rib and was hospitalized. It was also alleged that Resident #3 was physically assualted by Resident #4. To investigate the allegation on 05/29/24, between 1:00pm and 2:00pm, staff interviews were initiated. Interviews revealed that R1 and R2 had a disagreement in their room that led to an altercation. R1 tried to punch R2 and fell in the process. R2 denied hitting R1. Both R1 and R2 are non-ambulatory. When staff heard the commotion, they went to the room and accessed each resident. R1 was sent to the hospital since they were complaining of pain. R1 was moved to another room and R2 will be vacating the facility at the end of this month. Moreover,R3 and R4 had a non physical altercation in their room with staff present. Staff stated that there was no physical contact between the residents and both were re-directed. LPA was not able to speak

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

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-20240528164626

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 GROVE, LLC	FACILITY NUMBER: 197610442
	VISIT DATE: 05/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

to the residents since they were not in the community at the time of this visit. R1 is at the hospital. R2 is moving to another board and care, R3 had a medical appointment, and R4 was not present at the time of this visit. Between 2:30pm and 3:00pm, LPA reviewed facility records. Records confirmed what staff told LPA.

Based on interviews and records review, there is not sufficient information to support this allegation. Hence the allegation is UNSUBSTANTIATED at this time.

It was alleged that staff did not provide a safe environment for residents in care. To investigate this allegation, between 1:00pm and 2:00pm, staff interviews were initiated. Interviews revealed that staff do their best to provide a safe environment to all residents in care.. The staff are constantly supervising and checking in on residents. Between 2:00pm and 3:00pm resident interviews were initiated. Interviews revealed that residents feel safe at the facility.

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

No health and safety issues noted at the time of this visit.

Exit interview conducted and a copy of the report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 05/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2