197603165-3-16-2022-29-AS-JAPL-CDGPFZ-20220414111731

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 03/16/2022
Date Signed: 03/16/2022 08:36:06 PM

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. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/30/2021 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20210930102747

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:	03/16/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Janyce Pink		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident is not receiving medications as prescribed.
Staff do not properly report incidents involving a resident.
Staff do not provide adequate care and supervision to a resident.
Staff are preventing a client from contacting emergency services.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent complaint visit to the facility today. The LPA met with Administrator Janyce Pink at 10:30 a.m., and explained the reason for the visit.
During the initial visit on 10/06/2021, the LPA toured the facility and requested documents pertinent to the investigation.

On 03/16/2022, the LPA conducted staff interviews from 11:00 a.m. to 11:30 a.m., residents’ interviews from 12:00 p.m. to 1:30 p.m., and audited medications from 11:30 to 12:00 p.m. Additional records were requested pertinent to the investigation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

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 29-AS-20210930102747

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT VALLEY VILLAGE	FACILITY NUMBER: 197603165
	VISIT DATE: 03/16/2022

NARRATIVE

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Regarding the allegation: Resident is not receiving medications as prescribed. It is alleged that the Resident #1 (R1) has not been receiving their medication, and did not receive the medication as requested by R1, at night for pain. It is alleged that the pain medication wasn’t given until the next morning. At the time of the investigation, R1 was no longer at the facility, and was not interviewed. It is not known which was the night that the R1 needed the medication. As such, the LPA was unable to audit R1’s medications, as they were provided to R1 upon departure. To investigate this allegation, LPA Urena interviewed ten residents and two staff members. Interviews revealed that residents did receive their medications either in the morning before meals or with meals during lunch time, depending on the doctor’s orders. The residents stated that their medication comes in bubble packs from the pharmacy, and that the medical technician (med tech) removes the medication and places the medication in small white cups. The LPA interviewed Staff #1(S) about medication distribution to residents. The S1 stated that residents recieve their medication in the morning before breakfast if the medication is to be taken on an empty stomach, and after breakfast or lunch if medication is to be taken with food. The LPA requested an audit of the medication for the ten residents interviewed. Audit was compared to the Centrally Stored Medication. The audit revealed that according to the prescription date on the bottle/bubble, number of pills prescribed, and pills remaining in the bubbles, the medication is being administered according to doctors’ orders.

Based on the information obtained, there is insufficient evidence to support the claim that Resident is not receiving medications as prescribed. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff do not properly report incidents involving a resident. It is alleged that the staff are not making reports to the appropriate agencies such as North Los Angeles Regional Center (NLARC) when changes happen with residents. To investigate this allegation, LPA Urena interviewed ten residents and two staff members. Residents records review revealed that staff had sent to NLARC a report for R1 dated 9/17/2021. Additional reports sent by staff to NLARC were available for for review. Residents’ interviews revealed that they are not aware of the reports made by the facility staff to the supporting agencies. Staff interviews revealed that administrative staff makes reports as needed to the supporting agencies, and the medical technicians communicate with physicians’ offices for medication needs. Staff #1(S1) stated that they communicate with doctor’s office when medications prescriptions have expired, and any questions about their medications or if resident refuses to take medication as prescribed. Based on the information obtained, there is insufficient evidence to support the claim that Staff do not properly report incidents involving a resident. This allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20210930102747

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. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT VALLEY VILLAGE	FACILITY NUMBER: 197603165
	VISIT DATE: 03/16/2022

NARRATIVE

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Regarding the allegation: Staff do not provide adequate care and supervision to a resident. It is alleged that staff do not help residents with physical needs to move from upstairs to downstairs. At the time of the investigation, R1 was no longer at the facility, and was not interviewed. To investigate this allegation LPA Urena interviewed ten residents and two staff members. Residents’ interviews revealed that staff are helpful, and that staff assists with the cleaning of their rooms, vacuuming, washing their clothes, toilet paper needs, bathing, etc. Residents interviewed did not have any special needs (physical), residents were all ambulatory and alert. Staff interviewed stated that they assist residents, and attempt to address their needs in a timely manner, however sometimes there are priorities or staff shortage that may delay the services to residents. Based on the information obtained, there is insufficient evidence to support the claim that Staff do not provide adequate care and supervision to a resident. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff are preventing a client from contacting emergency services. It is alleged that staff said that they will not keep calling an ambulance for Resident #1(R1), because R1 needs to stop going to the hospital. At the time of the investigation, R1 was no longer at the facility, and was not interviewed. To investigate this allegation LPA Urena interviewed ten residents and two staff. Resident interviews revealed that nine out of ten residents stated that they have not had the need to call emergency services (9-1-1). However, residents noted that if they needed 9-1-1 services, they would call the front desk to do it for them. One resident stated that they had to call 9-1-1 before, and had no problem. Other times the front desk have called 9-1-1 for them. The staff interviewed reported that some residents want to call 9-1-1 for mental health issues, and that staff have indeed helped residents calm down before deciding on making the call to the 9-1-1 services. Based on the information obtained, there is insufficient evidence to support the claim that Staff are preventing a client from contacting emergency services. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview was conducted, the report was reviewed with the administrator. Signatures were obtained. A copy of the report was provided.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2022

LIC9099 (FAS) - (06/04)

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