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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 10/11/2024
Date Signed: 10/11/2024 03:23:39 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.ASC, 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
10/03/2024 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20241003151416
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: 133DATE:
10/11/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Jessica PelayaTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff are withholding resident's funds
Staff not keeping facility free from bed bugs.
Staff does not keep facility clean.
INVESTIGATION FINDINGS:
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On 10/11/2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth met with the Administrator, Jessica Pelaya. LPA explained the purpose of this visit was to interview residents and deliver the findings. LPA Spaeth interviewed fifteen (R1 – R15) out of 133 residents at 10:00 am until 11:30 am.

The investigation consisted of the following: On 10/10/2024, LPA Melissa Spaeth and Angelica Segovia conducted an initial visit. LPAs toured the facility at 9:35 am until 10:10 am. LPAs requested and reviewed the following records at 10:10 am until 10:25 am; (1) resident roster (2) residents’ documents; (3) staff roster; (4) exterminator schedule; and (5) facility personal and incidental funds. LPA received copies of the documentation. LPAs viewed ten out of sixty rooms with the maintenance staff member (S1) at 10:25 am until 11:15 am. LPAs interviewed the back-up Administrator at 11:00 am until 11:20 am.

Continued on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024
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-20241003151416
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY
FACILITY NUMBER: 197610032
VISIT DATE: 10/11/2024
NARRATIVE
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Regarding the allegation: staff are withholding a resident’s funds. It’s alleged a resident has not received their monthly funds for the past two months. R1 to R15 unanimously confirmed they receive their monthly personal and incidental funds. LPA interviewed the back-up administrator who stated they give the funds to the residents each month and have never missed.

Regarding the allegation: Staff are not keeping the facility free from bed bugs. It’s alleged the facility has had bed bug issues for some time. LPAs checked ten rooms. There were no bed bugs in the two beds within each room and there were no bugs in the corners of the room or on the floor. The maintenance staff member (S1) confirmed the entire facility was professionally sprayed during the month of May 2024. S1 stated if a resident suspects there is a bed bug in their room, the professional exterminator will spray the specific room. LPAs' reviewed the bed bug service reports which confirms the professional exterminator has sprayed various rooms. The exterminator will spray the room, submit a bed bug service report with the date the room was sprayed, and the exterminator will initial the report. The professional exterminator has been spraying various rooms from May, 2024 until September, 2024. LPAs received copies of the reports which is proof the facility has been professionally sprayed for bugs. R1 to R15 unanimously confirmed they have not seen any bed bugs within the facility.

Regarding the allegation: Staff does not keep the facility clean. It’s alleged that the facility is dirty and smells like urine. During the tour of the facility, LPAs observed three staff members cleaning residents' rooms, the common areas, and the hallways. LPAs did not smell any urine but did smell the cleaning solutions that were used during the cleaning process. R1 to R15 unanimously confirmed their rooms are cleaned each day and they do not smell urine in the facility.

Based on interviews and record review, the allegations are unsubstantiated.

An exit interview was conducted and a copy of the report was given.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Melissa Spaeth
LICENSING EVALUATOR SIGNATURE:

DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2