197610442-1-26-2026-31-AS-TAGD-DSRSHK-20260402135341

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 01/26/2026
Date Signed: 01/26/2026 02:54:35 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
01/23/2026 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20260123142414

FACILITY NAME:	LEISURE VALE ASSISTED LIVING		FACILITY NUMBER:	197610442
ADMINISTRATOR:	STEPHANIE ODEN		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS STREET		TELEPHONE:	(818) 244-2323
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 165	DATE:	01/26/2026
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Nilda Mercado, Administrative Service Coordinator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not ensure residents records were properly managed

INVESTIGATION FINDINGS:

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On 01/26/26, at 9:15am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Nilda Mercado, Administrative Service Coordinator. LPA explained the purpose of this visit was to gather information and deliver findings regarding this complaint.

On 01/26/26, between 9:25am-2:30pm, LPA Saucedo conducted a physical tour, conducted resident and staff interviews and delivered findings for this complaint.

LIC 9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

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 5

Control Number 31-AS-20260123142414

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: 01/26/2026

NARRATIVE

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Regarding the allegation: Staff did not ensure residents records were properly managed. It is being alleged that Resident #1 (R1) received a bill for blood they had withdrawn at the above facility. During LPA's interview with R1, R1 confirmed that they did not have proof of a bill that they were being charged on behalf of a blood draw. LPA interviewed sixteen (16) other residents that confirmed they have had blood withdrawn at the facility but they have never received a bill. LPA interviewed five (5) staff, four (4) out of the five (5) staff did not know about how a resident gets billed, they only provide medication disbursement. One (1) staff out of the five (5) staff confirmed that residents only get blood withdrawn at the above facility if their insurance covers it. Furthermore, that same staff confirmed if a resident's insurance refused to pay the bill they would get an email saying the resident's insurance was not covering the bill. In addition, that staff also confirmed that R1 gets Medical and Medicare and should not be getting charged for anything. LPA obtained R1's Identification and Emergency Information and Admission Record that confirms R1 gets both Medical and Medicare. Therefore, based on the LPA's observations, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the Administrative Service Coordinator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 5

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
01/23/2026 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20260123142414

FACILITY NAME:	LEISURE VALE ASSISTED LIVING		FACILITY NUMBER:	197610442
ADMINISTRATOR:	STEPHANIE ODEN		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS STREET		TELEPHONE:	(818) 244-2323
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 165	DATE:	01/26/2026
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Nilda Mercado, Administrative Service Coordinator		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff does not ensure residents medications are properly managed

INVESTIGATION FINDINGS:

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Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 31-AS-20260123142414

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: 01/26/2026

NARRATIVE

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Regarding the allegation: Staff does not ensure residents medications are properly managed. It is being alleged that Resident #1-(R1) received a new pain medication and it was not provided to them. LPA asked for R1's MAR-Medication Administration Record and it was determined by reviewing R1's MAR, that the pain medication was never noted in the facility's medication system and on the MAR. LPA received R1's pain medication prescription from R1's new Health Insurance and the doctor that prescribed it. R1's medication was prescribed on 01/09/26. LPA conducted a physical review of R1's medication and noticed that pain medication was in a bubble pack stored in R1's medication packet in the medical technician's cart and the following dates were missing 01/20/26-01/26/26. It is a morning medication but there was no notation that it was being provided to R1. LPA interviewed the medical technician that confirmed R1's pain medication was provided that morning (01/26/26) but they did not document it anywhere because the new pain medication was not on the MAR list. Although, LPA interviewed sixteen (16) residents that confirm they receive their medication, R1 continues to confirm that they are not receiving their pain medication. LPA interviewed five (5) staff that confirmed that R1 should have been receiving their pain medication but because there was no documentation of R1 receiving their pain medication they cannot determine if R1 ever received it. Therefore, based on the LPA's observations, staff and resident interviews, the above allegation(s) above is SUBSTANTIATED at this time.

An exit interview was conducted, citation(s) were issued, an appeals right was provided and a copy of this report was given to the Administrative Service Coordinator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 31-AS-20260123142414

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/09/2026 Section Cited CCR 87411(d)(4)	1 2 3 4 5 6 7	Personnel Requirements: All personnel shall be given on the job training or have related experience with knowledge required to safely assist with prescribed medications. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Administrator/Licensee shall conduct an in-service training to all staff regarding medication. POC 02/09/26
	8 9 10 11 12 13 14	Based on LPA's observation and interviews, the licensee/administrator did not comply with the section cited above by providing R1 their medication everyday and/or when prescribed which posed a potential Health, Safety, or Personal Rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 5