197603165-12-5-2021-31-AS-NGID-C9QN49-20211215090731

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 12/04/2021
Date Signed: 12/05/2021 05:55:54 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/19/2020 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20200219141501

FACILITY NAME:	GLEN PARK AT VALLEY VILLAGE		FACILITY NUMBER:	197603165
ADMINISTRATOR:	PINK, JR, TILLMAN		FACILITY TYPE:	740
ADDRESS:	5527 LAUREL CANYON BLVD		TELEPHONE:	(818) 769-6626
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	100	CENSUS: 34	DATE:	12/04/2021
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Jessica Rosado		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident has scabies
Adequate food service is not provided to residents
Residents diapers not changed in a timely manner
Staff handles resident in a rough manner
Facility did not ensure changes in resident's condition were reported to the responsible party.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent complaint visit to finish investigation into the allegations above. LPA met with facility staff and explained the reason for this visit.

Resident has scabies
It is alleged that a resident had scabies. This allegation has already been investigated previously with regards to complaint control number 31-AS-20200218121919. It was determined on 2/4/21 that the allegation was deemed Unsubstantiated. This allegation was alleged on 2/19/20. During the course of the investigation it was found that there was a small scabies outbreak and that the Department of Public Health was notified and residents who had scabies were isolated according to protocol. This allegation is deemed Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2021

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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Control Number 31-AS-20200219141501

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: GLEN PARK AT VALLEY VILLAGE	FACILITY NUMBER: 197603165
	VISIT DATE: 12/04/2021

NARRATIVE

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Adequate food service is not provided to residents
It is alleged that residents are not provided good food service. LPA conducted interviews with residents regarding this allegation from approximately 3:20-4pm. LPA also toured the facility kitchen and checked the food supply from 3-3:20pm. Information from interviews revealed that residents are fine with the food service that is provided by the facility. Based on the information obtained through interviews and observation this allegation is deemed Unsubstantiated at this time.

Residents diapers not changed in a timely manner
It is alleged that residents who require assistance with incontinence care are not changed in a timely manner. LPA conducted interviews with residents who require assistance with incontinence care from 3:20-4pm. Information obtained from interviews conducted reveal that there has been no recent issues with residents being changed in a timely manner. Based on the information obtained this allegation is deemed Unsubstantiated at this time.

Staff handles resident in a rough manner
It is alleged that residents who require assistance with incontinence care are handled roughly. LPA conducted interviews with residents regarding this allegation from 3:20-4pm. Information obtained from interviews reveal that staff are not handling residents in a rough manner. Based on the information obtained this allegation is deemed Unsubstantiated at this time.

Facility did not ensure changes in resident's condition were reported to the responsible party.
It is alleged that facility did not contact resident #1 (R1) responsible person when they went to the hospital. Interviews revealed that this alleged incident happened on 2/16/20. During that time there was a different administrator working at the facility. Despite numerous attempts LPA was unable to contact the former administrator regarding that allegation. Staff interviewed stated they believed R1's responsible party was contacted. Due to not having enough information this allegation is deemed Unsubstantiated at this time.

Exit Interview conducted.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 12/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2021

LIC9099 (FAS) - (06/04)

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