197610032-10-6-2025-31-AS-TAGD-DNT27Y-20251126160931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 10/06/2025
Date Signed: 10/06/2025 03:05:47 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
09/29/2025 and conducted by Evaluator Angelica Segovia

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250929114618

FACILITY NAME:	LEISURE GARDEN SENIOR ASSISTED LIVING FACILITY		FACILITY NUMBER:	197610032
ADMINISTRATOR:	CRYSTAL BARRIENTOS		FACILITY TYPE:	740
ADDRESS:	44523 15TH STREET WEST		TELEPHONE:	(661) 941-4578
CITY:	LANCASTER	STATE: CA	ZIP CODE:	93534
CAPACITY:	157	CENSUS: 130	DATE:	10/06/2025
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Crystal Barrientos- Administrator		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Facility staff does not allow resident to choose their own healthcare provider.

INVESTIGATION FINDINGS:

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On 10/06/2025 at approximately 09:50 AM, Licensing Program Analyst (LPA), Angelica Segovia conducted an unannounced initial complaint visit to the facility to investigate the above allegation(s). LPA was greeted by the Wellness Director, Rovelyn Thomas and stated the reason for their visit. The Administrator, Crystal Barrientos arrived shortly after to assist with today’s visit.

To investigate the allegation(s) at 10:00 AM, LPA requested census, resident and staff roster. At approximately 10:15 AM, LPA requested pertinent documents pertaining to the investigation such as but not limited to: Home Health records, Pre-Appraisal and visitation log. At 10:30 AM LPA conducted a physical plant tour, to ensure the health and safety of the residents. Between 10:30 AM to 2:00 PM, LPA attempted interviews with seventeen (17) residents (R1-R17) and two (2) staff members (S1-S2).

(Continue to LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025

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-20250929114618

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: 10/06/2025

NARRATIVE

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Regarding the allegation: Facility staff does not allow resident to choose their own healthcare provider. It was alleged that staff did not allow a home health agency to provide services to Resident 1 (R1). To investigate the allegation, LPA conducted interviews with two (2) staff members and attempted interviews with seventeen (17) residents. Interviews with both staff members stated that they did not refuse services for R1 and only requested R1’s Plan of Care to better assist R1’s needs and services. S2 stated when they requested R1’s Plan of Care, the agency denied the request due to, “HIPPA Laws”. LPA’s interview with S1 revealed the same information was given to them from the home health agency. LPA’s interview with the Reporting Party (RP) confirmed the HIPPA information was relayed to the facility staff. LPA’s interview with R1 revealed that they are enrolled in Home Health and they can choose their own provider. When questioned if home health is providing services, R1 stated, “Yea”. LPA conducted additional interviews with nine (9) residents. All nine (9) residents stated they can choose their own care provider. LPA attempted to interview R11-R17 but due to either: their various medical diagnosis, refusal to be interviewed and/or not available, they could not be interviewed, therefore LPA terminated the interviews. During LPA’s record review, LPA reviewed the facility’s visitation log from September 2025 to Present. LPA’s record review revealed that R1’s home health agency conducted a visit on 9/24/2025. Further record review confirmed that R1’s Services Consent Forms for Admission to the home health agency were dated for the same date as the home health visit of 9/24/2025. Additional record review revealed that R1’s home health agency has conducted additional visits to the facility since. LPA's record review of the facility's Unusual Incident/Injury Report (SIR) revealed the facility self-reported the incident to Community Care Licensing Division (CCLD) dated 9/30/2025. Review of the SIR revealed the incident between the facility and home health agency were disclosed regarding R1's Plan of Care, but no denial of services for R1 were documented.

Based on interviews and record review, 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: 10/06/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025

LIC9099 (FAS) - (06/04)

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