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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 09/17/2025
Date Signed: 09/17/2025 01:37:18 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
09/11/2025 and conducted by Evaluator Angelica Segovia
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250911124329
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: 131DATE:
09/17/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:CRYSTAL BARRIENTOS- AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Licensee does not ensure that facility elevator is maintained in good repair.
INVESTIGATION FINDINGS:
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On 9/17/2025 at approximately 10:20 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced initial complaint visit to the facility. LPA was greeted by the Administrator, Crystal Barrientos and stated the reason for their visit was to investigate the above allegation(s).


To investigate the allegation(s), at approximately 10:25 AM, LPA requested relevant documentation. By 11:00 AM, LPA conducted a physical plant tour. From 11:30 AM to 01:30 PM, LPA conducted record review and interviewed The Administrator.

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

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
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 5
Control Number 31-AS-20250911124329
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: 09/17/2025
NARRATIVE
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Regarding the allegation: Licensee does not ensure that facility elevator is maintained in good repair. It was alleged that the facility’s elevator has been broken. To investigate the allegation, LPA conducted an interview with the Administrator. Interview with the Administrator revealed that one (1) of the two (2) elevators is currently not working. The Administrator stated that the company working on the elevator have claimed it to be "Technical Issues”. They stated that they have been communicating with the company to see when they can return to fix elevator 1. When questioned by LPA how many residents on the second floor are non-ambulatory, The Administrator stated there are a total of seven (7) non-ambulatory residents. The Administrator stated, four (4) use wheelchairs but can walk and the other three (3) use walkers for assistance. LPA’s record review of Unusual Incident/Injury Report (SIR) revealed that the facility had self-reported the maintenance of elevator 1 along with the dates of services listed to Community Care Licensing Division (CCLD). LPA confirmed through record review the dates the elevator company was dispatched to the facility to work on elevator 1. During LPA’s physical plant tour, LPA observed elevator 1 to be off and not in working condition. However, LPA observed the second elevator (Elevator 2) to be working. LPA observed residents using elevator 2. Additionally, LPA used elevator 2 and observed the elevator to be working and in proper condition.

Based on interviews, record review and observation, the facility has one of the two elevators working and have done their due diligence in requesting maintenance work on Elevator 1 to be fixed, 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.

Let it be noted LPA Segovia had to email the report to the Administrator due to technical issues of LPA's printer.

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

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
09/11/2025 and conducted by Evaluator Angelica Segovia
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250911124329

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: 131DATE:
09/17/2025
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:CRYSTAL BARRIENTOS- AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not properly addressing pest infestation in the facility.
INVESTIGATION FINDINGS:
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5
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13
On 9/17/2025 at approximately 10:20 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced initial complaint visit to the facility. LPA was greeted by the Administrator, Crystal Barrientos and stated the reason for their visit was to investigate the above allegation(s).


To investigate the allegation(s), at approximately 10:25 AM, LPA requested relevant documentation. By 11:00 AM, LPA conducted a physical plant tour. From 11:30 AM to 01:30 PM, LPA conducted record review and interviewed The Administrator.

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

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20250911124329
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: 09/17/2025
NARRATIVE
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Regarding the allegation: Staff are not properly addressing pest infestation in the facility.

It was alleged that the facility has not kept the facility free from pest. To investigate the allegation, LPA conducted an interview with the Administrator. Interview with the Administrator revealed that they have not had any concerns brought to their attention regarding bedbugs. They stated they have pest control services come out throughout the year to fumigate areas of the facility including residents’ rooms. Additionally, the Administrator revealed once a year, the entire facility is fumigated. LPA confirmed the facility’s fumigation services while conducting record review. However, during LPA’s physical plant tour, LPA toured a total of thirteen (13) random rooms located on both floors. During LPA’s tour, one (1) of the thirteen (13) rooms was observed to have what appeared to be a bedbug crawling on the mattress. LPA observed the Administrator to press down on the bug where red spillage (assumed to be blood) was then exposed from said bug.

Based on LPA’s observation of the visible pest (bedbug) to be on the mattress, the allegation is Substantiated at this time.

Citation issued, please refer to LIC 9099-D. Civil penalty assessed.

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

Let it be noted LPA Segovia had to email the report to the Administrator due to technical issues of LPA's printer.

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

DATE: 09/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20250911124329
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/03/2025
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary... at all times. Maintenance shall include...for the safety and well-being of residents...

This requirement is not met as evidenced by:
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The licensee agreed to have fumigation services provided to the room affected including the surrounding areas of the facility. Additionally, the licensee will order protective mattress covers and dispose of the affected mattress. Proof will be emailed to LPA Segovia by POC due date.
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LPA observed a bed bug on the mattress of one of the thirteen rooms toured 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: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5