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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 06/12/2024
Date Signed: 06/12/2024 05:10:43 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
06/10/2024 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20240610154955
FACILITY NAME:LEISURE GROVE, LLCFACILITY NUMBER:
197610442
ADMINISTRATOR:MAYA MNOYANFACILITY TYPE:
740
ADDRESS:413 E. CYPRESS STREETTELEPHONE:
(818) 244-2323
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:199CENSUS: 151DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
11:37 AM
MET WITH:Nilda Mercado, Business Office ManagerTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not safeguard residents belongings
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegation. LPA met with Nilda Mercado Business Officer Manager and explained the reason for the visit.

It was reported that staff did not safeguard residents belongings. To investigate this allegation on 06/12/2024, between 12:00pm and 12:30pm, staff interviews were initiated. Interviews revealed that Resident #1 ( R1) arrived to the facility on 04/16/2024 at approximately 2:30pm and left the community at approximately 4:30pm the same day. R1 did not return to the facility to pick up their belongings or to sleep there and never signed the admissions agreement. They left the facility before the paper work was finalized. In regards to R1's personal belonings, they were placed in the facility storage.

Based on interviews there is not sufficient information to support this allegation. Hence, the allegation is UNSUBSTANTIATED at this time.
No health and safety issues noted at the time of this visit.
Exit interview conducted and a copy of the report was issued.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
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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