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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 01/24/2025
Date Signed: 01/24/2025 04:06:29 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
12/31/2024 and conducted by Evaluator Melissa Spaeth
COMPLAINT CONTROL NUMBER: 31-AS-20241231084604
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: 122DATE:
01/24/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jessica PelayaTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not assist resident with catheter care as per admission agreement
Facility staff did not dispense medications to resident as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 1/24/2025 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth was met by the Administrator, Jessica Pelaya and LPA explained the purpose of this visit was to review resident’s records, conduct interviews, and present the findings.

The investigation consisted of the following: On 01/06/2025, LPAs Spaeth and Segovia conducted an initial complaint investigation. As of today, LPA Spaeth reviewed residents' records at 9:30 am until 10:00 am and received copies of the documentation. LPA also received a copy of the resident roster and the staff work schedule. LPA Spaeth reviewed residents' medications and the medication records

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

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
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 31-AS-20241231084604
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: 01/24/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 at 10:00 am until 11:00 am. LPA received copies of the residents’ medication records. LPA Spaeth interviewed thirteen (13) out of one hundred twenty-two (122) residents at 11:00 am until 12:00 pm. LPA interviewed ten (10) out of fifty (50) staff members at 12:00 pm until 12:30 pm.

Regarding the allegation, Facility staff did not assist resident with catheter care as per admission agreement: it is being alleged a resident had a clogged foley catheter and the catheter had not been flushed by staff. The resident (R1) who has a catheter stated when staff observed the clogged catheter, they immediately called 911 and R1 was transported to the hospital. R1 also stated staff explained R1 was being sent to the hospital so that a medical professional could flush out the catheter. Staff members (S1 – S6) confirmed this occurred.

Regarding the allegation, Facility staff did not dispense medications to resident as prescribed: it is being alleged a resident had not received their medication. R1-R13 confirmed they receive their medication in a timely manner each day. S1-S10 confirmed residents receive their medication each day.

Based upon LPA’s review of the resident’s records and the interviews conducted, the allegations are unsubstantiated.

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

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

DATE: 01/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2025
LIC9099 (FAS) - (06/04)
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