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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 08/29/2024
Date Signed: 08/29/2024 02:55:59 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
08/22/2024 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20240822110519
FACILITY NAME:LEISURE GROVE, LLCFACILITY NUMBER:
197610442
ADMINISTRATOR:MAYA MNOYANFACILITY TYPE:
740
ADDRESS:413 E. CYPRESS STREETTELEPHONE:
(818) 244-2323
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:199CENSUS: 156DATE:
08/29/2024
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Brandy Rangel, Assistant AdminiistratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility staff did not provide a copy of admission agreement to resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegation. LPA met with Assistant Administrator Brandy Rangel and explained the reason for the visit.

It was reported that facility staff did not provide a copy of the admission agreement to a resident. Resident #1 (R1) recalls signing the admission agreement, but believes they did not receive a copy of it. To investigate this allegation on 08/29/2024, between 11:00am and 12:00pm, LPA initiated staff interviews. Inteviews revealed that staff did provide a copy of the admission agreement to R1. When R1 signed their admission agreement and was given a copy, they then disputed the fact that they had a share of cost to pay to the facility. LPA was not able to speak to R1 since they were out of the community at the time of this visit. Between 12:00pm and 1:00pm, LPA reviewed facility records. Records conirmed what staff told LPA.

Based on interviews and records review there is not sufficient information to support the allegation. Thus this allegation is UNSUBSTANTIATED at this time.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
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-20240822110519
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: 08/29/2024
NARRATIVE
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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: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2