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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 06/16/2026
Date Signed: 06/16/2026 01:53:07 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
06/11/2026 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20260611160903
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: 160DATE:
06/16/2026
UNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Stephanie Oden, AdministratorTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Staff are not following resident's doctors orders
Staff are not administering resident's medication in a timely manner
INVESTIGATION FINDINGS:
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On 06/16/26, at 8:05am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Stephanie Oden, Administrator. LPA explained the purpose of this visit was to gather information and deliver findings for this complaint.

On 06/16/26, LPA Saucedo conducted the initial, complaint visit. At 8:15am, LPA conducted a physical tour and interviewed staff and residents.

LIC 9099C-continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
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 2
Control Number 31-AS-20260611160903
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: 06/16/2026
NARRATIVE
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Regarding the allegation: Staff are not following resident's doctors orders. It is being alleged that the nurse practitioner changed resident #1 (R1)'s order to where they only get their suppository three (3) times per week instead of the original two (2) times per day as needed. During LPA's interview with R1, R1 stated, "yes, the nurse practitioner changed my order when I am supposed to get my suppository everyday and I need my suppository to have a bowel movement." LPA did obtain R1's prescription orders and R1's suppository order was changed by the nurse practitioner. Three (3) staff were interviewed that confirmed R1's suppository order was changed recently but they are only following the current prescription orders which cannot be over written and would have to be changed back to it's original order by a prescribed medical personnel. Therefore, based on the staff and resident interviews and pertinent documents obtained the allegation(s) is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff are not administering resident's medication in a timely manner. It is being alleged that resident #1 (R1) waited one (1) time for eight (8) hours and the facility ended up calling home health to come give them their suppository. During LPA's interview with R1, R1 stated, "they do not remember if a licensed vocational nurse was on grounds but the medical technician that was on duty told them that they could not give them the suppository." R1 also stated to LPA that their original prescription of suppository was "one (1) in the morning and one (1) as needed (PRN) in the afternoon and now it is changed and they are upset." Furthermore, R1 could not remember the day they had to wait eight (8) hours for a suppository. LPA did interview three (3) staff that confirmed the suppository is supposed to be provided to R1 by a skilled professional such as a licensed vocational nurse that is on duty and furthermore, the facility has an outside agency named "Clipboard" that has licensed vocational nurse in addition to other staff when regular staff are not present. The three (3) staff did confirm that R1 now has a new prescription of suppository of it being originally everyday to now every other day. In addition, R1 does have home health services which have provided R1 their suppository before. Let it be noted, LPA did obtain R1's medication list. Therefore, based on the staff interviews and resident interview obtained the allegation(s) is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 06/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2