197610442-12-19-2025-31-AS-NGID-DQZ29N-20260204161214

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 12/19/2025
Date Signed: 12/19/2025 05:46:43 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
09/15/2025 and conducted by Evaluator Angela Panushkina

COMPLAINT CONTROL NUMBER: 31-AS-20250915150605

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:	12/19/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Stephanie Oden, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not provide adequate supervision resulting in an altercation between residents.

INVESTIGATION FINDINGS:

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At 12:00pm, Licensing Program Analyst (LPA), Angela Panushkina and conducted a subsequent visit to deliver final report. LPA met with the Administrator and explained the reason for the visit.

Initial visit was conducted on 09/23/25 and during course of the investigation, LPA requested resident and staff roster. At 09:55am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, Facility's Abuse Policy, House Rules and Staff Training relevant to the investigation. At approximately 10:00am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected. Between 10:10am – 2:00pm, LPA conducted interviews with the Administrator, three (3) staff, two (2) MedTechs and fourteen (14) out of seventeen (17) residents.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

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-20250915150605

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: 12/19/2025

NARRATIVE

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Allegation: Staff did not provide adequate supervision resulting in an altercation between residents.

It was alleged that on 09/10/25 R1 got slapped by R2 and staff did not provide adequate supervision. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that during the morning and afternoon shifts (from 7am – 3:00pm) the facility has six (6) to seven (7) staff members, including two (2) MedTechs. LPA was also informed that the staff is always available to redirect residents in case an altercation or any type of disagreement between the residents occurs. Interview with three (3) staff members confirmed the statement provided by the Administrator. All staff interviewed informed the LPA that no serious injury was reported during R1's and R2’s incident. This was the first time that R1 and R2 had an altercation and no previous incidents between the two had ever happened in the past. According to the R1's Physician's Report (dated on 07/13/23) and R2's (dated on 04/29/25) both residents have a history of depression. Administrator also informed LPA that R1 has a history of confusion, however, both residents have never had a history of aggression. Interviews with fourteen (14) out of seventeen (17) residents revealed that residents may occasionally argue and or disagree, however, the staff is well trained to prevent altercation and an immediate staff intervention/redirection is being provided. According to a police report (dated on 09/10/25), R2 instigated the altercation when R2 interrupted a conversation between R1 and another resident, which turned into an argument, and then R2 slapped R1 one time on the right side of the face. The two were eventually separated by the staff and no further medical attention was required or requested by both residents.

Although there was an altercation between R1 and R2, that lead to R2 striking R1, there wasn't enough evidence to prove that staff did not prevent resident from hitting another resident in care, as there was staff supervision present to intervene and redirect both residents. Moreover, licensee did submit an Incident Report (IR) to the Licensing agency regarding the incident. Therefore, based on the information obtained the allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC9099 (FAS) - (06/04)

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