197610442-7-15-2024-31-AS-NMAN-DHPPWZ-20250616114132

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 07/10/2024
Date Signed: 07/15/2024 08:43:09 AM

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
07/10/2024 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20240710101309

FACILITY NAME:	LEISURE GROVE, LLC		FACILITY NUMBER:	197610442
ADMINISTRATOR:	MAYA MNOYAN		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS STREET		TELEPHONE:	(818) 244-2323
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 154	DATE:	07/10/2024
		UNANNOUNCED	TIME BEGAN:	11:03 AM
MET WITH:	Brandy Rangel, Assistant Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Facility staff did not respond in a timely manner to Resident's call pendant

Staff failed to provide emergency medical services in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegations. LPA met with Assistant Administrator Brandy Rangel and explained the reason for the visit.

It was reported that staff did not respond in a timely manner to Resident #1 (R1's) call pendant. To investigate this allegation on 07/10/2024, between 11:00am and 12:30pm, staff interviews were initiated. Interviews revealed that neither R1 or Resident #2 (R2) pushed the call pendant. R1 was taken to their room from the dinning room at approximately 9:00pm by staff due to appearing tired. Shortly after being placed in the bed, R1 fell asleep. Staff continued to frequently monitor R1. R1 slept until approximately 10:30pm, when staff noticed that they were grunting and had vomited. Staff immediately assessed R1 and after evaulating them decided to call 911. LPA attempted to speak to R2 but they refused to answer questions. Between 12:30pm and 1:30pm, faciliy files were reviewed. Records revealed that R1 had serveral underlying medical conditions.
Continue on C-9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

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-20240710101309

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 GROVE, LLC	FACILITY NUMBER: 197610442
	VISIT DATE: 07/10/2024

NARRATIVE

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Based on interviews and records review there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.

It was alleged that Staff failed to provide emergency medical services in a timely manner, To investigate this allegation on 07/10/2024, between 11:00am and 12:30pm, staff interviews were initiated. Interviews revealed that R1 was in the dinning room talking to fellow residents when they were given their medication at 8:00pm, At the time that medication was dispensed, R1 did not appear to be ill or in distress. Approximately one hour later, R1 was taken to their room by staff because they looked tired. Between 9:00pm and 10:30pm, R1 was being checked on and monitored by staff. At approximately, 10:30pm, Staff #1 (S1) went to R1's room and noticed that they were grunting and had vomit. S1 called Staff #2 (S2) to assess R1 and take the vital signs. According to S2, R1's vital signs were within normal range, but they noticed that R1 was clammy .S2 called the paramedics and R1 was taken to the hospital. Between 12:30pm and 1:30pm, faciliy files were reviewed. Records revealed that R1 had several underlying medical conditions and took various medications.

Based on interviews and records review there is not sufficient information to support this allegation. Hence, this allegation is UNSUBSTANTIATED at this time.

No health and safety issues noted at the time of this visit.

Exit interview conducted and a copy of the report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

LIC9099 (FAS) - (06/04)

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