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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603437
Report Date: 04/16/2025
Date Signed: 04/16/2025 03:20:58 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/30/2025 and conducted by Evaluator Angela Barutyan
COMPLAINT CONTROL NUMBER: 29-AS-20250130133758
FACILITY NAME:LEISURE LIVING INC.FACILITY NUMBER:
197603437
ADMINISTRATOR:PARVIN HASHEMIFACILITY TYPE:
740
ADDRESS:30821 CATARINA DR.TELEPHONE:
(818) 687-8855
CITY:WESTLAKE VILLAGESTATE: CAZIP CODE:
91362
CAPACITY:6CENSUS: 6DATE:
04/16/2025
UNANNOUNCEDTIME BEGAN:
03:03 PM
MET WITH:Lina RoxasTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Resident fractured their hip due to lack of care from staff
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angela Barutyan conducted a subsequent complaint visit to deliver investigation finding. Upon arrival, LPA met with staff who called Administrator Michelle Mauer. Entrance interview conducted.

On 01/30/2025, Community Care Licensing Division received a complaint alleging Resident #1 (R1) sustained a hip fracture due to staff neglect. The complaint was referred to the Community Care Licensing (CCL) Investigations Branch (IB) and assigned to Investigator Edward Hector.

On 01/31/2025, LPA T. Camara conducted an initial complaint visit to this facility for the above allegation. During the visit, LPA Camara spoke with staff at 11:23AM and spoke with the co-administrator at 11:25AM, reviewed and obtained pertinent documents at 11:37AM, conducted a brief tour of the facility/health and safety check at 11:49AM and interviewed one (1) resident at 11:50AM. CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
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 29-AS-20250130133758
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: LEISURE LIVING INC.
FACILITY NUMBER: 197603437
VISIT DATE: 04/16/2025
NARRATIVE
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On 02/07/2025, between the hours of 2PM-4PM, Investigator Hector conducted interviews with R1 and R1’s responsible party.

Information gathered during the course of the investigation revealed that R1 attempted to transfer without assistance around 12:40AM on 11/15/2024, resulting in a fall. R1 requires transfer assistance and has a bell next to their bed to call staff for assistance. R1 did not ring the bell or notify staff before attempting to self-transfer. Staff immediately found R1 and called for paramedics who transferred R1 to the hospital for further evaluation. Facility notified R1’s responsible party. R1’s medical assessment dated 06/17/2024 identifies R1 as a fall risk and that R1 and care-staff shall be instructed on fall prevention measures. The facility implemented the bell next to R1’s bed to mitigate fall risk. R1’s appraisal dated 07/22/2024 and physician’s report dated 04/04/2024 document R1 as alert and social without dementia. R1 stated that the fall was not the facility’s fault and took accountability. R1’s responsible party had no concerns of lack or quality of care from staff. Based on the above information gathered, although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Resident fractured their hip due to lack of care from staff” is deemed UNSUBSTANTIATED at this time.

LPA reviewed report with Administrator telephonically. Administrator was unable to be present for the visit and designated staff Lina Roxas to sign the report.



No citations issued at this time. Exit interview conducted and a copy of the report was provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Angela Barutyan
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025
LIC9099 (FAS) - (06/04)
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