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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 05/05/2026
Date Signed: 05/05/2026 01:15:16 PM

Substantiated


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
01/07/2026 and conducted by Evaluator Angelica Segovia
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20260107113426
FACILITY NAME:LEISURE VALE ASSISTED LIVINGFACILITY NUMBER:
197610442
ADMINISTRATOR:STEPHANIE ODENFACILITY TYPE:
740
ADDRESS:413 E. CYPRESS STREETTELEPHONE:
(818) 244-2323
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:199CENSUS: 172DATE:
05/05/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Stephanie Oden- AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff are mismanaging resident's medication.
Staff did not give resident a 60 day notice for increase in rent.
INVESTIGATION FINDINGS:
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On 05/05/2026 at approximately 9:30 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced subsequent complaint visit to the facility. LPA was greeted by the Administrator, Stephanie Oden and stated the reason for their visit was to deliver the findings of the complaint.


To investigate the allegation(s), on 1/15/2026 at approximately 10:00 AM, LPA conducted a physical plant tour. By 11:00 AM, LPA requested relevant documentation. From 11:30 AM to 3:00 PM, LPA attempted interviews with one (1) residents (R1), six (6) staff members (S1-S6) and conducted record review.


(Continue to LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
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 6
Control Number 31-AS-20260107113426
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: 05/05/2026
NARRATIVE
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Regarding the allegation: Staff are mismanaging resident's medication. It was alleged that staff had mismanaged R1’s medication. To investigate the allegation, LPA conducted interviews with one (1) resident and five (5) staff members. LPA’s interview with R1 revealed that on multiple occasions, staff have not distributed their medication on time, have mixed other residents’ medication with their Medication Administrator Records (MARs) and have not refilled their medication in a timely manner. LPA’s interview with all five (5) staff members confirmed that R1’s medication is distributed on time (there is a two (2) hour window for medication pass), recorded correctly on the Medication Administration Records (MARs) and refilled in a proper time frame. All five (5) staff members confirmed that resident’s medications are administered as prescribed. However, during LPA’s record review of R1’s MARs, LPA observed on 1/15/2026 it was shown R1 was given one of their prescribed medications by S5. When LPA conducted a record review of R1’s medication, LPA observed said medication could not be found. Upon further review it was revealed that the medication was not yet available. LPA’s interview with S5 revealed they had mistakenly marked medication as taken and were planning on correcting it on the MARS. Additionally, LPA’s review of R1’s medication, LPA observed two (2) medications to be missing resulting in S1 having to go to the medication room to find said medication. S1 was able to locate one (1) of the two (2) medications during LPA’s visit.

Based on interviews, record review and observations there is enough information to verify the allegation. Therefore, the allegation is SUBSTANTIATED at this time.

Regarding the allegation: Staff did not give resident a 60 day notice for increase in rent. It was alleged that staff did not provide R1 with a 60-day notice of rent increase. To investigate the allegation, LPA conducted interviews with one (1) resident and two (2) staff members. LPA’s interview with S2 revealed that R1 is under the program of Assisted Living Waiver (ALW) and receives Social Security Administration (SSA). LPA’s interview with S2 revealed that R1’s rent is paid directly to the facility by the third-party provider (SSA). S2 revealed that R1’s rent increase occurs annually which is determined by SSA and not them. S2 revealed that SSA will send notification to all residents who are SSA recipients, and the facility themselves have posted the announcement on the community bulletin.

(Continue to LIC 9099-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 31-AS-20260107113426
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: 05/05/2026
NARRATIVE
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LPA’s interview with R1 revealed that staff never gave them their notice of rent increase nor did they receive notice from SSA. R1 stated staff had them sign a form for their room rate to increase due to them having a private room. LPA’s record review confirmed R1’s “Addendum to Residence and Care Agreement for Residents with Third-Party Payer Source” for their room rate change dated 1/01/2026. LPA's interview with S2 correlated the room rate change for R1's single room occupancy stating they, "...agreed to a single room which is a rate increase. We have the copy".

Further record review of R1’s file, LPA observed R1’s notice of rent increase due to SSA benefit increases effective January 1, 2025, dated 12/1/2024, and addressed to R1. However R1’s file did not contain the new notice reflecting the rent increase of 2026 for SSA benefit increase. During LPA’s physical plant tour, LPA observed the facility’s posting of the rent increase of 2026 labeled, "New Rates for Room and Board" posted in the hallway’s passageway located near the medication room on the first floor. When LPA questioned S2 if R1 had been given a notice of their rent increase correlating with the posting LPA observed in the hallway, S2 stated, “No”.

Based on interviews, record review and observations there is enough information to verify the allegation. Therefore, the allegation is SUBSTANTIATED at this time.

Citations issued, please refer to LIC 9099-D

No other immediate health and safety issues observed during the day of the visit. Exit interview was conducted, appeal rights given, and a copy of this report was provided to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Citations on this Visit Report are Under Appeal!

Control Number 31-AS-20260107113426
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: 05/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/19/2026
Section Cited
CCR
87465(c)(2)
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87465 Incidental Medical and Dental Care. (c)...facility staff designated by the licensee shall be permitted to assist the resident with self-administration...(2) Once ordered by the physician the medication is given according to the physician's directions.
This requirment was not met evidenced by:
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The Administrator/Licensee will conduct an in service-training with staff regarding medication distribution and record keeping of the MARs which will then be emailed to LPA Segovia by POC due date: 5/19/2026
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Based on interviews, record review and observations, S5 had incorrectly marked R1's MARs with a medication that was not yet available which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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Under Appeal
Type B
05/12/2026
Section Cited
CCR
87507(g)(4)
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87507 Admission Agreements. (g)Admission agreements shall specify...(4) Modification conditions...at least 60 days prior written notice to the resident of any rate or rate structure change, or as soon as the licensee is notified of SSI/SSP rate changes.
This requirment was not met evidenced by
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The Administrator/Licensee will review the regulation and email LPA Segovia a statement of understanding by POC due date: 5/12/2026
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Based on interviews, record review and observations, R1 was not provided with their 60 days rent increase which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
01/07/2026 and conducted by Evaluator Angelica Segovia
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20260107113426

FACILITY NAME:LEISURE VALE ASSISTED LIVINGFACILITY NUMBER:
197610442
ADMINISTRATOR:STEPHANIE ODENFACILITY TYPE:
740
ADDRESS:413 E. CYPRESS STREETTELEPHONE:
(818) 244-2323
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:199CENSUS: 172DATE:
05/05/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Stephanie Oden- AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
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9
Staff did not provide resident with her records.
INVESTIGATION FINDINGS:
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3
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5
6
7
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10
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12
13
On 01/15/2026 at approximately 9:30 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced subsequent complaint visit to the facility. LPA was greeted by the Administrator, Stephanie Oden and stated the reason for their visit was to deliver the findings of the complaint.


To investigate the allegation(s), on 1/15/2026 at approximately 10:00 AM, LPA conducted a physical plant tour. By 11:00 AM, LPA requested relevant documentation. From 11:30 AM to 3:00 PM, LPA attempted interviews with one (1) residents (R1), six (6) staff members (S1-S6) and conducted record review.


(Continue to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 31-AS-20260107113426
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: 05/05/2026
NARRATIVE
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Regarding the allegation: Staff did not provide resident with her records. It was alleged that staff did not provide R1 with their file upon their request. To investigate the allegation, LPA conducted interviews with one (1) resident and two (2) staff members. LPA’s interview with S1 revealed that R1 had only requested a copy of their medication list and their Admission Agreement, which was provided to them. LPA’s interview with S2 revealed that R1 only requested their Assisted Living Waiver (ALW) information, which they too provided. Both staff stated R1 did not request their entire file. LPA’s interview with R1 stated they had requested their medication information due to concerns of their medication being mismanaged. LPA observed R1 to have a copy of their medication list. When questioned how they obtained their medication list, R1 informed LPA it was provided to them by the facility staff.

Based on interviews, R1 confirmed they received their medication list and LPA observed them to be of possession of said information. There is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No immediate health and safety issues observed during the day of the visit. Exit interview was conducted and a copy of this report was provided to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6