197603165-7-1-2021-29-AS-DPEA-C56QB3-20210722120052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 07/01/2021
Date Signed: 07/01/2021 01:59:09 PM

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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/30/2021 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20210630084112

FACILITY NAME:	GLEN PARK AT VALLEY VILLAGE		FACILITY NUMBER:	197603165
ADMINISTRATOR:	PINK TILLMAN		FACILITY TYPE:	740
ADDRESS:	5527 LAUREL CANYON BLVD		TELEPHONE:	(818) 769-6626
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	100	CENSUS: 36	DATE:	07/01/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Pink Tillman Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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9

Illegal Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced complaint investigation for the above allegation. LPA met with Assistant Administrator Elizabeth Flores and explained the reason for the visit.
Between 9:45am - 2:30pm, LPA conducted physical plant, interviewed staff and residents. LPA also reviewed and obtained copies of pertinent documents relevant to the investigation.

In regards to the allegation of illegal eviction, LPA records review and interview with staff revealed that Resident 1 (R1) was never issued an eviction notice and R1 was never told they had to vacate the facility. LPA interview with R1 revealed that R1 is actively looking to relocate to their own apartment. R1 also stated that they informed staff they plan to relocate from this facility within 30 days. Based on information gathered during this visit, the department does not have sufficient evidence to determine that facility illegally evicted resident. Therefore the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted. Report issued and sent via Email.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 07/01/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2021

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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