197610442-5-30-2025-31-AS-NMAN-DHTU8X-20250620152216

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 05/30/2025
Date Signed: 05/30/2025 07:05:07 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
08/22/2024 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240822110519

FACILITY NAME:	LEISURE GROVE, LLC		FACILITY NUMBER:	197610442
ADMINISTRATOR:	MAYA MNOYAN		FACILITY TYPE:	740
ADDRESS:	413 E. CYPRESS STREET		TELEPHONE:	(818) 244-2323
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	199	CENSUS: 173	DATE:	05/30/2025
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Angela Smith, Administrator		TIME COMPLETED:	06:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not provide a copy of admission agreement to resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

This is the addendum of the investigation report previously issued on 08/29/24.
Licensing Program Analyst (LPA)Antonia Alvizar-Ettima conducted an unannounced visit to conduct additional investigation for the above noted allegation. LPA met with Administrator and explained the reason for the visit.

The investigation of the above allegation was initiated by the LPA Rosaura Valenzuela on 08/29/24 at which time LPA interviewed facility staff and residents. At the time of this visit, at 10:10a.m. LPA Alvizar- Ettima and Administrator conducted facility tour. At 11:25a.m. LPA conducted interview with seventeen (17) out of one-hundred and seventy-three (173) residents. At 1:30a.m. LPA spoke with facility staff regarding R1. In addition, at 2:30p.m. LPA reviewed facility records, including, but not limited to R1’s facility admission agreement and other documents pertaining to allegation.
Prior to this visit on 4/30/25 LPA Alvizar-Ettima interviewed R1 over the phone and asked questions regarding their Admission Agreement.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

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-20240822110519

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 GROVE, LLC	FACILITY NUMBER: 197610442
	VISIT DATE: 05/30/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Facility staff did not provide a copy of admission agreement to resident

It was reported that facility staff did not provide a copy of the admission agreement to a resident #1 (R1).
To investigate this allegation on 08/29/24, between 11:00am and 12:00pm, LPA Valenzuela initiated staff interviews. Interviews revealed that staff did provide a copy of the admission agreement to R1. However, when R1 signed their admission agreement and was given a copy, R1 refused to take a copy because they disputed the fact that they had a share of cost to pay to the facility. LPA Valenzuela was not able to speak to R1 due to being out of the community. Other residents interviewed during todays visit verified receiving copies of their admission agreements. R1 recalled writing their initial and signing many documents in the facility’s business office. R1 also recalled signing admission agreement but was unable to remember receiving a copy of it.

A review of facility records, conducted on 08/29/24 and at the time of this visit, verified the information received from staff and residents.

Based on interviews and records review there is not sufficient validity of the complaint, Thus, this 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.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2