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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610442
Report Date: 03/19/2026
Date Signed: 03/20/2026 08:19:01 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
08/14/2025 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20250814150705
FACILITY NAME:LEISURE VALE ASSISTED LIVINGFACILITY NUMBER:
197610442
ADMINISTRATOR:ANGELA SMITHFACILITY TYPE:
740
ADDRESS:413 E. CYPRESS STREETTELEPHONE:
(818) 244-2323
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:199CENSUS: 173DATE:
03/19/2026
UNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Stephanie Oden, Administrator TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility staff are not adhering to resident care plan.
Facility staff do not provide adequate care and supervision to resident in care.
Facility staff are unable to communicate effectively with the residents.
Facility staff do not communicate with authorized representative in a timely manner.
Staff did not answer the facility phone in a timely manner.
INVESTIGATION FINDINGS:
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At 12:10pm, Licensing Program Analyst (LPA), Angela Panushkina conducted a subsequent visit to deliver final findings. LPA met with the Administratove Service Coordinator and, Nilda Mercado, explained the reason for the visit. The Administrator arrived shortly after.

An initial complaint visit was conducted on 08/15/25 by LPA Alvizar-Ettima. During that visit LPA requested resident and staff roster. At approximately 10:40am, LPA conducted a physical plant tour, to ensure the health and safety of the residents in care. At 11:20am, LPA requested copies of pertinent information which include, but not limited to Physician’s Report, Admission Agreement, Appraisal Needs and Services Plan, Centrally Stored Medication and Destruction Record (CSMDR), Medication Administration Record (MAR), Staff Training, relevant to the investigation.

Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
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 3
Control Number 31-AS-20250814150705
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LEISURE VALE ASSISTED LIVING
FACILITY NUMBER: 197610442
VISIT DATE: 03/19/2026
NARRATIVE
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On 11/20/2025 at 9:20am, LPA Panushkina conducted subsequent visit and interviewed with the Administrator, three (3) staff, two (2) MedTechs and fourteen (14) out of seventeen (17) residents.

Allegation: Facility staff are not adhering to resident care plan

It was alleged that R1 was not provided with adequate care and the staff did not follow care plan by failing to cut his/her food and provide assistance with feeding. To investigate this allegation, LPA conducted an interview with the Administrator and three (3) staff members. All parties interviewed denied the above allegation and informed LPA that they were well aware of R1’s medical condition and the care plan was always followed. However, R1 would sometimes refuse meals and request cold liquids instead, due to his/her throat cancer. Additionally, three (3) staff members informed LPA that after multiple attempts to feed R1 during each meal, the staff would no longer push and or force R1 to eat their food because they did not want to violate R1’s personal rights. Fourteen (14) residents interviewed expressed no concern regarding this allegation and confirmed that their dietary orders are always followed by the kitchen staff and their personal rights are protected by the facility staff. Lastly, during physical plant tour, LPA observed posters throughout the kitchen notifying kitchen staff of resident’s preferences/special diets. LPA also observed that effective 07/22/2024, R1’s doctor ordered No Concentrated Sweets (NCS) due to R1’s diabetes. Therefore, based on interviews, record reviews and LPA observations, this allegation is deemed Unsubstantiated at this time.

Allegation: Facility staff do not provide adequate care and supervision to resident in care

Interview with the Administrator revealed that prior to employment, all staff are provided with “Basic Services” training and provided with copies of training to LPA. Additionally, LPA conducted interviews with fourteen (14) out of seventeen (17) residents and all residents interviewed expressed no concern regarding this allegation. LPA was informed that the facility staff will try their best to meet everyone's needs by providing good care and to ensure residents receive adequate care and supervision. Lastly, LPA observed staff appear to demonstrate proper knowledge in the interactions of the day. Interviews with staff also confirmed that they have been trained in a variety of the mandatory training. Therefore, based on interviews, this allegation is deemed Unsubstantiated at this time.


Continue on LIC9099-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250814150705
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: LEISURE VALE ASSISTED LIVING
FACILITY NUMBER: 197610442
VISIT DATE: 03/19/2026
NARRATIVE
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Allegation: Facility staff are unable to communicate effectively with the residents

It was alleged that R1 often tried to communicate with staff, but many did not understand R1’s requests due to a language barrier. To investigate this allegation, LPA conducted an interview with the Administrator and was informed that all staff members providing care and supervision to residents communicate in English. All three (3) staff and two (2) MedTechs interviewed were able to communicate with the LPA basic knowledge and procedures in the event of an emergency. Fourteen (14) residents interviewed expressed no concern regarding this allegation. LPA was informed that the staff can effectively understand, communicate, and treat the residents with dignity and respect. LPA conducted multiple visits to this facility and did not observe residents or staff having difficulty communicating with each other. Therefore, based on interviews and LPA observation, this allegation is deemed Unsubstantiated at this time.

Allegation: Facility staff do not communicate with authorized representative in a timely manner

The Administrator, three (3) staff and two (2) MedTechs interviewed denied the above allegation. LPA was informed that the Wellness Director and the Administrator did communicate with R1’s responsible party, on multiple occasions, regarding R1’s changes/updates. Fourteen (14) out of seventeen (17) residents interviewed expressed no concerns regarding this allegation, and informed LPA that staff maintain their authorized representatives/significant others informed of their status at all times. Therefore, based on interviews this allegation is deemed Unsubstantiated.

Allegation: Staff did not answer the facility phone in a timely manner

Prior to visiting the facility, LPA called the facility multiple times, and every call was answered by the facility staff/concierge. Interview with the Administrator revealed that the facility receives enormous calls and if staff are unable to answer, it goes to voicemail. Every voicemail received is addressed promptly. Interview with the concierge confirmed the statement provided by the Administrator. LPA was also informed that the facility did not have issues with the phone lines and in the event that the phone lines are not operating properly, staff have contact information for the Technical Support Department (available 24 hours per day/7 days per week). Fourteen (14) residents interviewed expressed no concern regarding this allegation and informed LPA that the phone calls are regularly answered and staff check daily voicemail and return calls immediately. Therefore, based on interviews and observation, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. Appeal rights explained and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3