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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 07/24/2025
Date Signed: 07/24/2025 12:27:10 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
07/15/2025 and conducted by Evaluator Angelica Segovia
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250715144637
FACILITY NAME:LEISURE GARDEN SENIOR ASSISTED LIVING FACILITYFACILITY NUMBER:
197610032
ADMINISTRATOR:CRYSTAL BARRIENTOSFACILITY TYPE:
740
ADDRESS:44523 15TH STREET WESTTELEPHONE:
(661) 941-4578
CITY:LANCASTERSTATE: CAZIP CODE:
93534
CAPACITY:157CENSUS: 129DATE:
07/24/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:CRYSTAL BARRIENTOS- AdministratorTIME COMPLETED:
12:45 PM
ALLEGATION(S):
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Staff mishandled a resident's personal belongings.
Staff mishandled a resident's medications.
INVESTIGATION FINDINGS:
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On 7/24/2025 at approximately 10:00 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced subsequent complaint visit to the facility. LPA was greeted by the Administrator, Crystal Barrientos and stated the reason for their visit was to deliver the findings of the complaint.

To investigate the allegation(s), on 7/16/2025 at approximately 11:00 AM, LPA requested relevant documentation. By 11:30 AM, LPA conducted a physical plant tour. From 12:00 PM to 2:00 PM, LPA conducted record review and interviewed one (1) resident (R1), two (2) staff members (S1-S2) and two (2) witnesses (W1-W2).


(Continue to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
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 3
Control Number 31-AS-20250715144637
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: 07/24/2025
NARRATIVE
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Regarding the allegation: Staff mishandled a resident's personal belongings. It was alleged that R1’s personal belongings were not cared for properly. To investigate the allegation, LPA interviewed one (1) resident, two (2) staff members and two (2) witnesses. Interview with both staff members and both witnesses revealed that R1’s belongings were infested with parasitic insects from the facility they were being relocated from. Interview with S1 revealed that they told R1 they could only bring their main necessities that were not infested, and all other belongings could not be transported at the time including R1’s television. Such items that were able to be transported to the facility included R1’s undergarments and medication. S1 did confirm that they had placed R1’s belongings outside but as a precautionary measure to ensure any parasitic insects were no longer viable and could not spread within the facility. Further interview with S1 revealed that the facility provided a television for R1’s bedroom. LPA’s interview with R1 confirmed that they were made aware that not all of their belongings could be transported due to the infestation. LPA’s record review of R1’s Personal Property and Valuables (SPV) showcased that R1’s belongings included such items as: undergarments and compact discs but no television. Further record review of the facility’s Unusual Incident Report (SIR) revealed that S1 attempted to contact R1’s previous residence to acquire about their television and other belongings; where they were told that R1’s television was not there nor their other belongings in question. During LPA’s physical plant tour, LPA observed R1’s room to be equipped with such items as: clothing, telephone charger and compact discs. Additionally, LPA observed a television that was provided by the facility.

Based on interviews, record review and observation there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff mishandled a resident's medications. It was alleged that staff failed to provide R1 with their medication. To investigate the allegation, LPA interviewed one (1) resident, two (2) staff members and one (1) witness. Interview with both staff members and witness revealed that the facility R1 was relocated from provided R1’s medical devices and medication. However, LPA’s interview with S1 revealed that not all of R1’s medications were provided. S1 stated that when R1 was relocated, R1’s Centrally Store Medication Record (CSDMR) was not provided, which limited the facility’s knowledge of what medications R1 had been prescribed. Due to this, S1 stated they are in the process of obtaining current and updated documentation pertaining to R1. When questioned about R1’s recent hospitalizations, S1 stated that R1 was sent to the hospital for medical reasons, one pertaining to R1 expressing their medical devices were not providing enough support. S1 stated R1 was then able to obtain additional prescriptions to help with their current medical needs. (Continue to LIC 9099-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250715144637
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: 07/24/2025
NARRATIVE
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LPA’s record review confirmed that the facility did seek out medical treatment for R1 by sending them to the hospital and reported the incident to the appropriate reporting parties including Community Care Licensing Division (CCLD). LPA’s interview with R1 confirmed that the facility they were relocated from did not provide them with all of their medication including their respiratory aid and stated they had been without it, “…for quite some time”. Further record review confirmed that R1 was not provided with their respiratory aid when they were relocated. Additional record review confirmed that the facility had obtained an updated prescriptions order for R1 and their CSDMR showcased their medication had been given accordingly, including a new prescription for their respiratory aid. During LPA’s physical tour LPA observed R1’s bedroom to be equipped with their medical devices. LPA observed the devices to be in good condition.

Based on interviews, record review and observation there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No immediate health and safety issues observed during the day of the visit. Exit interview conducted and a copy of this report was provided to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3