197603165-3-18-2022-31-AS-CHAS-CCUPBJ-20220325111025

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 03/18/2022
Date Signed: 03/18/2022 05:45:21 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
02/26/2020 and conducted by Evaluator Yelena Avetisyan

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20200226140132

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: 36	DATE:	03/18/2022
		UNANNOUNCED	TIME BEGAN:	05:00 PM
MET WITH:	Qwutaria Rogers - Office Manager		TIME COMPLETED:	05:50 PM

ALLEGATION(S):

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Staff is mishandling residents while in care
Staff is mishandling residents’ personal funds while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Yelena Avetisyan conducted a subsequent complaint visit for the allegations listed above.

Regarding the allegations listed above it was reported that Staff 1(S1) is abusing/mishandling the residents and stealing their money at this facility and at Glen Park at Long Beach.

On 1/31/2021, 2/1/2021 and 2/5/2021 LPA Avetisyan made attempts to speak with the complainant to obtain additional details and identifying information for residents related to the complaint allegations. The attempts made were unsuccessful. On 2/8/2021, LPA Avetisyan conducted interviews with Mr. Rafael Silva who was the Assistant Administrator at the time the complaint was filed with the department.

On 12/3/2021 and 12/4/2021 LPA’s Smith and Tan conducted a subsequent complaint visit to the facility regarding complaint control # 31-AS-20200219141501 and complaint control # 31-AS-20200225090656. During those visit the LPA’s conducted interviews with residents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Yelena Avetisyan	TELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

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-20200226140132

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: 03/18/2022

NARRATIVE

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On 3/16/2022 LPA conducted interview with staff who is named in the complaint.

Interviews conducted revealed that S1 visits the facility sporadically and does not have any contact with residents. When interviewed the residents denied experiencing or observing other residents abused/mishandled by S1 or any other staff.

When interviewed S1 and Assistant administrator both informed the LPA that the licensee has an accounting department that deals with the residents P&I funds. The P&I funds are deposited to the facility account and distributed to the residents on site. At disbursement the resident and the staff both sign the form. When a resident leaves the facility or passes away the money is returned to the residents’ family/responsible party or the Social Security administration by the accounting department.

Additionally, the above allegations were also investigated and unsubstantiated for Glen Park at Long Beach.

Based on the lack of information provided and interviews conducted the allegations listed above are Unsubstantiated at this time. Exit interview conducted and copy or report emailed to jpink@GlenParkSeniorLiving.com

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Yelena Avetisyan	TELEPHONE: (818) 378-8120
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2022

LIC9099 (FAS) - (06/04)

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