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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610032
Report Date: 11/26/2025
Date Signed: 11/26/2025 01:39:21 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
11/20/2025 and conducted by Evaluator Angelica Segovia
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20251120102142
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: 130DATE:
11/26/2025
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Crystal Barrientos- AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Staff signed POLST for resident who cannot consent.
Staff signed resident up/ signed paperwork for Hospice without consent of resident.
INVESTIGATION FINDINGS:
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On 11/26/2025 at approximately 9:20 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.

To investigate the allegation(s), at approximately 09:30 AM, LPA conducted a physical plant tour. By 10:30 AM, LPA requested relevant documentation. From 10:30 AM to 1:30 PM, LPA conducted record review and interviewed one (1) staff member (S1).

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

DATE: 11/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
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-20251120102142
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: 11/26/2025
NARRATIVE
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Regarding the allegation: Staff signed POLST for resident who cannot consent. It was alleged that the Administrator (S1) had signed resident’s (R1) Physician Orders for Life-Sustaining Treatment (POLST) without their consent. To investigate the allegation, LPA conducted interview with S1 where it was revealed that R1 upon admission to the facility did not have any next of kin or authorized legal representative. When questioned as to why they signed R1’s POLST, S1 denied signing the document. Per S1 the signatures did not match and proceeded to showcase paperwork from R1's file comparing their signature. LPA observed S1’s signature not to match the one shown on R1’s POSLT documentation. During LPA’s record review, LPA conducted a review of six (6) residents on Hospice where it was shown that S1 has not signed any of their consent forms or POSLT. Further record review showcased that S1 had not become the Administrator until 5/12/2025 which revealed discrepancy with R1’s POLST documentation where S1 was listed as the Administrator dated 12/23/2024.

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

Regarding the allegation: Staff signed resident up/ signed paperwork for Hospice without consent of resident. It was alleged that S1 had signed R1’s consent forms for Hospice without their knowledge or ability to consent. To investigate the allegation, LPA conducted an interview with one (1) staff member. LPA’s interview with S1 revealed that they did not sign R1’s Hospice documentation. Per S1, their signature had been done so fraudulently and without their knowledge nor consent. LPA’s review of S1’s signature compared to those documented on R1’s Hospice “Informed Consent” forms were observed to not match. Further record review of R1’s file showcased that the hospital had placed an order to have R1 admitted into Hospice on 12/23/2024. Further record review revealed that R1 was under an order of “Bio Ethics” by the hospital due to their medical diagnosis and lack of family/friend’s involvement; which resulted in the hospital becoming the designated decision maker of their medical treatments.

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: 11/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/26/2025
LIC9099 (FAS) - (06/04)
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