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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 03/01/2024
Date Signed: 03/01/2024 04:09:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
02/22/2024 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20240222134011
FACILITY NAME:LEISURE GARDEN SENIOR ASSISTED LIVING FACILITYFACILITY NUMBER:
197610032
ADMINISTRATOR:JESSICA PELAYAFACILITY TYPE:
740
ADDRESS:44523 15TH STREET WESTTELEPHONE:
(661) 941-4578
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:157CENSUS: 131DATE:
03/01/2024
UNANNOUNCEDTIME BEGAN:
11:27 AM
MET WITH:Crystal BarrientosTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Facility staff did not safeguard resident's belongings.
INVESTIGATION FINDINGS:
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On 03/01/2024 at 11:27 a.m. Licensing Program Analysts (LPAs) Evelin Rios and Melissa Spaeth conducted an unannounced complaint visit to the facility to investigate the above allegation. LPAs met with Assistant Administrator Crystal Barrientos and explained the purpose of the visit. Entrance interview conducted.

A physical plant tour was conducted at approximately 11:42 a.m. by LPAs along with the Assistant Administrator to ensure the health and safety of the residents in care. LPAs observed water damage running along a wall on north side of the first floor. According to Crystal the facility recently experienced a water leak due to the recent rain in the area. The leak has been addressed and the cosmetic repair is expected to be completed by Wednesday, March 6, 2024.

Allegation: Facility staff did not safeguard resident's belongings. It is alleged clothing is not being returned to residents after laundry is completed. To investigate the allegation LPAs conducted a tour of both laundry rooms in the facility and obtained records relevant to the investigation. ( Continued on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
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 3
Control Number 31-AS-20240222134011
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY
FACILITY NUMBER: 197610032
VISIT DATE: 03/01/2024
NARRATIVE
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From approximately 12:00 p.m. to 1:25 p.m. LPAs interviewed three (3) staff that have provided laundry service for residents and fourteen (14) out of one hundred one (131) randomly selected residents. From approximately 1:30 p.m. LPA reviewed the facility's laundry schedule for residents found to need the assistance, LIC 500, and facility program mentioning laundry services. Interview with the assistant administrator revealed the facility has added new large capacity washers, explained the facilities laundry process and revealed the designated person for laundry no longer works for the facility and currently the Direct Care Provider (DSP) Supervisor is overseeing laundry services. DCPs have been instructed to assist with laundry and follow a schedule for residents needing the assistance but will assist any resident who requests laundry service. The assistant administrator also discussed the facility's process for documenting residents personal belongings when they first arrive to the facility. According to the assistant administrator many of the residents and their families have refused documenting or inventorying item brought in by residents or items provided to them by family when they are already at the facility. Interviews with seven (7) out of fourteen residents (14) corroborate either personally having various clothing gone missing after it was collected for laundry or arriving to the facility with items that they have later never seen again. Interview with two (2) out of three (3) staff corroborate they have heard residents and their families' complain about clothing going missing after laundry service. According to interviews with staff the facility is working on the issue and has implemented procedures to return clothes to the right resident. Although residents' interviewed could not recall exactly which items have gone missing or if they had completed an inventory of items during the admission process, interviews with both residents and staff revealed they had brought up their issues with laundry service to staff and management.

Based on interviews conducted, the above allegation is found to be SUBSTANTIATED at this time. Deficiencies cited (refer to 9099-D).

Exit interview was conducted with administrator. A copy of the report and appeal rights provided.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20240222134011
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY
FACILITY NUMBER: 197610032
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/15/2024
Section Cited
CCR
87217(b)
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87217(b)Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff...
This requirement was not met by evidence of:
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The Licensee will create a laundry service procedure that will ensure residents' clothing is returned to them and review procedure with staff. Once completed Licensee will send a copy of laundry procedure and a staff signed in sheet indicating the laundry procedure has been reviewed by them. Submit documentation to LPA by POC due date.
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Based on interviews conducted with staff and residents the licensee failed to take appropriate measures to return residents' personal property after laundry service which poses a potential health, safety, or personal rights risk to persons in care.
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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.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 03/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024
LIC9099 (FAS) - (06/04)
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