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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 07/24/2026
Date Signed: 07/24/2026 08:17:17 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
12/10/2025 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20251210092920
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: 162DATE:
07/24/2026
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Stephanie OdenTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff did not provide meals to resident in care in accordance with the resident's modified diet.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to investigate the above allegations. LPA met with Stephanie Oden and explained the reason for the visit.

--- Staff did not provide meals to resident in care in accordance with the resident's modified diet.

It was alleged that Resident #1 (R1) needs to be on a low sodium diet due to his high blood pressure, but staff have provided some foods high in sodium. R1 refused to eat some of them. To investigate the allegation on December 18, 2025, LPA requested documents at around 10:00a.m. LPA also interviewed seventeen (17) residents and four (04) staff from 11:30a.m. – 2:30p.m. A review of R1’s physician’s report states that R1 has a low fat, low sodium dietary restriction. During the physical plant tour, LPA did not observe documentation or any other available information in the kitchen regarding R1’s dietary restriction.
(CONT. on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026
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-20251210092920
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: 07/24/2026
NARRATIVE
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During interviews, Staff #2 (S2) stated, “When I started here there were a lot of papers all over the place, very disorganized and so I created this”. R1’s name was not on the list. During interviews, all residents stated the food meets their dietary needs. R1 did not wish to be interviewed.

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

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

No other health and safety hazards noted during the visit.
Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026
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
12/10/2025 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20251210092920

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: 162DATE:
07/24/2026
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Stephanie OdenTIME COMPLETED:
06:00 PM
ALLEGATION(S):
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Staff threatened resident in care
Staff did not provide housekeeping services to resident in care
Staff did not safeguard resident's confidential information
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to investigate the above allegations. LPA met with Stephanie Oden and explained the reason for the visit.

--- Staff threatened resident in care.

It was alleged that Staff #1 (S1) told Resident #1 (R1) to not touch him and S1 threatened to push R1 if R1 were to touch him again. To investigate the allegation on December 18, 2025, LPA requested documents at around 10:00a.m. LPA also interviewed seventeen (17) residents and four (04) staff from 11:30a.m. – 2:30p.m. A review of the Department’s records did not show incident reports involving R1 and S1. During interviews, S1 stated they never said that to R1 or any other resident. All other staff stated they do not threaten residents and did not witness verbal altercations between R1 and S1.
(CONT. on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20251210092920
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: 07/24/2026
NARRATIVE
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During interviews, fifteen (15) out of seventeen (17) residents stated they are treated with respect and dignity. R1 did not wish to be interviewed.
Based on interviews, there is not enough information to verify the above allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff did not provide housekeeping services to resident in care

It was alleged that staff have refused to clean R1’s room and bathroom for the past weeks. R1 was not given an explanation why staff refuse to provide housekeeping services. To investigate the allegation on December 18, 2025, LPA requested documents at around 10:00a.m. LPA also interviewed seventeen (17) residents and four (04) staff from 11:30a.m. – 2:30p.m. A review of the staff schedule shows there are at least two (2) housekeepers per morning and afternoon shifts daily. During interviews, all staff stated resident rooms are cleaned at least two (2) times per week. Staff #3 (S3) added, residents do have the right to refuse but are unaware of R1’s refusal. During interviews with residents, five (5) out of seventeen (17) stated they are not receiving housekeeping services regularly. All other interviewed residents stated they receive housekeeping services regularly. R1 did not wish to be interviewed.
Based on interviews and record review, there is not enough information to verify the above allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff did not safeguard resident's confidential information

It was alleged that S1 told several residents that a resident had HIV and they should stay away from that person. To investigate the allegation on December 18, 2025, LPA interviewed seventeen (17) residents and four (04) staff from 11:30a.m. – 2:30p.m. During interviews all staff stated they do not disclose resident’s medical or personal information to residents and do not tell them to stay away from other residents. During interviews all residents stated they do not feel staff disclose their personal information or control who they communicate with. R1 did not want to be interviewed.
Based on interviews, there is not enough information to verify the above allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No other health and safety hazards noted during the visit.
Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 31-AS-20251210092920
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: 07/24/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/27/2026
Section Cited
CCR
87555(b)(7)
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87555 General Food Service Requirements (b) The following food service requirements shall apply:
(7) Modified diets prescribed by a resident's physician as a medical necessity shall be provided. This is not met as evidenced by;
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Administrator will submit proof of correction by the POC due date. Proof may be in the form of a picture showing all the residents' restrictions or proof of training. The Administrator will also submit a written statement explained they have reviewed and will adhere to Title 22 CCR 87555
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 Based on interviews and observations, S2 was not aware of R1’s dietary restrictions and LPA did not observe any documentation.
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General Food Requirements by the POC due date.
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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.
SUPERVISOR'S NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5