197603165-12-3-2021-31-AS-NGID-C9QNT9-20211215094424

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 12/03/2021
Date Signed: 12/03/2021 03:51:00 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
02/25/2020 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20200225090656

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:	12/03/2021
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Elizabeth Torres		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility staff failed to provide adequate food service
Facility staff are not trained to meet the needs of the residents.
Insufficient staffing
Facility staff failed to assist residents in a timely manner
Facility staff threatened resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s) Wendell Smith and Jose Gary Tan conducted an unannounced subsequent visit to investigate the allegations above. LPA met with the assistant administrator and explained the reason for this visit.
Facility failed to provide adequate food service
It is alleged that facility staff failed to bring food up to resident's rooms when they were sick. LPA's conducted interviews with residents from approximately 9:15-10:25am regarding this allegation. LPA's also conducted a tour of the facility kitchen and checked the food supply. LPA's observed there to be a sufficient amount of perishable and non perishable food. Based on the information obtained through interviews and observation 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: 12/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021

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-20200225090656

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: 12/03/2021

NARRATIVE

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Facility staff are not trained to meet the needs of the residents.
It is alleged that facility staff are not properly trained to serve the residents. Interviews were previously conducted with facility staff. LPA's randomly reviewed staff records for three staff from approximately 10:30-11am and observed them all to have the proper trainings. Based on the information obtained through interviews and record review this allegation is deemed Unsubstantiated at this time.

Insufficient staffing
It is alleged that the facility does not have enough staff. LPA's previously obtained a staff schedule and interviews were conducted with staff. LPA's conducted interviews with residents from 9:15-10:25am regarding this allegation. Based on the information obtained this allegation is deemed Unsubstantiated at this time.

Facility staff failed to assist residents in a timely manner
It is alleged that residents are not being assisted when they need help from staff. LPA's conducted interviews the residents from 9:15-10:25am. Interviews revealed that there were no issues with residents being assisted in a timely manner. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time.

Facility staff threatened resident
It is alleged that a resident was threatened by staff. There was not a specific resident or staff mentioned in this allegation. LPA's interviewed residents and asked them have they witnessed any residents being threatened and all interviewed stated they had not. Based on the information obtained through interviews 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: 12/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021

LIC9099 (FAS) - (06/04)

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