197610032-5-21-2025-31-AS-TAGD-DH6UGJ-20250530153424

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 05/21/2025
Date Signed: 05/21/2025 02:06:33 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
04/02/2025 and conducted by Evaluator Angelica Segovia

COMPLAINT CONTROL NUMBER: 31-AS-20250402085725

FACILITY NAME:	LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY		FACILITY NUMBER:	197610032
ADMINISTRATOR:	JESSICA PELAYA		FACILITY TYPE:	740
ADDRESS:	44523 15TH STREET WEST		TELEPHONE:	(661) 941-4578
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	157	CENSUS: 120	DATE:	05/21/2025
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	CRYSTAL BARRIENTOS- Administrator		TIME COMPLETED:	02:20 PM

ALLEGATION(S):

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Resident was sexually assaulted at facility.

INVESTIGATION FINDINGS:

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On 5/21/2025 at approximately 10:00 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced subsequent complaint visit. LPA was greeted by the Administrator Crystal Barrientos and stated the reason for their visit was to deliver the findings for the above allegation(s).

To investigate the allegation(s), on 5/21/2025 LPA conducted a physical plant tour at approximately 10:30 AM, requested pertinent documentation at around 11:20 AM and conducted interviews with eight (8) Residents (R2-R8) and seven (7) staff members (S1-S7) between 11:30 AM and 1:00 PM.

On 4/02/2025 the Woodland Hills South Adult and Senior Regional office received a complaint alleging sexual assault. The complaint was referred to the Community Care Licensing Investigation Branch (IB) and accepted as an assignment. The complaint was assigned to Special Investigator Assistant (SIA) Amina Luckett. On 4/03/2025, LPA Melissa Spaeth conducted the initial twenty-four (24) hour complaint investigation visit. (Continue on 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250402085725

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 GARDEN SENIOR ASSISTED LIVING FACILITY	FACILITY NUMBER: 197610032
	VISIT DATE: 05/21/2025

NARRATIVE

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The investigation determined the following: Regarding the allegation: Resident was sexually assaulted at the facility. It was alleged that Resident 1 (R1) was sexually assaulted by three (3) staff members.

Interviews with R2-R8 stated that they have never heard nor witnessed any staff member sexually abuse residents. Interview with R6 revealed that they have heard R1, “…talking or screaming to the voices in their head”. Interviews with S1-S8 confirmed that they have not witnessed or heard of any residents having been sexually assaulted from staff members. Interview with the Administrator revealed that when R1 was discharged from the hospital they returned to the facility. When the facility became aware of the alleged incident, the Administrator stated they proceeded to conduct their own internal investigation as well as reporting the incident to the appropriate domains. LPA’s record review confirmed that a Report of Suspected Dependent Adult/Elder Abuse was submitted on 4/03/2025 to Adult Protective Services (APS).

During a record review, LPA observed on 4/10/2025 SIA Luckett obtained the police report from the Special Victims Unit (SVU) where it stated that R1 was, “…scheduled to undergo a forensic sexual assault examination” but R1 later refused. Confirmation of refusal of the examination was confirmed on 4/29/2025 when SIA contacted the subpoena desk at Antelope Valley Medical Center regarding R1’s forensic exam where it was revealed R1 refused the exam. Additionally, on 4/10/2025 SIA subpoenaed R1’s medical records from Antelope Valley Medical Center.

LPA’s record review revealed that R1 has various mental health disorders. Unusual Incident Reports (SIRs) were submitted to CCLD which show R1’s history of requesting to be sent to the hospital due to hearing voices and not feeling mentally well. LPA’s review of the police report noted that R1’s story regarding the allegation was, “…often changing and contradicting”.

LPA’s review of medication revealed that R1’s care plan includes various medications which can cause side effects such as: agitation, suicidal tendencies, and/or vivid dreams such as nightmares.

Furthermore, based on interviews, record reviews and SIA’s investigation there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards were noted during the visit.

Exit interview was conducted and a copy of the report was provided to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 05/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025

LIC9099 (FAS) - (06/04)

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