197603165-4-6-2022-29-AS-JAPL-CDMUYT-20220419160029

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 04/06/2022
Date Signed: 04/06/2022 04:22:23 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
04/01/2022 and conducted by Evaluator Elsie Campos

COMPLAINT CONTROL NUMBER: 29-AS-20220401110453

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:	04/06/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Janyce Pink		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff is unlawfully evicting a resident while in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA’s) Elsie Campos and Ashley Smith arrived unannounced for a subsequent complaint visit. The LPAs met with Assistant Administrator Janyce Pink and explained the reason for the visit.

During today’s visit, the LPA’s spoke to staff at 10:38 a.m.,10:47 a.m., interviewed resident at 11:20 a.m. and reviewed records at 12:30 p.m.

Continued on LIC-9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

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 29-AS-20220401110453

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: 04/06/2022

NARRATIVE

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Allegation: Staff is unlawfully evicting a resident while in care

Regarding the complaint, it was alleged that Resident #1 (R1) was not being allowed to return to the facility after hospitalization. During today’s visit, it was discovered that R1 is currently at the facility. Thus, the LPA’s interviewed staff and R1. Interviews and record review revealed that R1 was hospitalized 3/19/2022 due to shortness of breath. Staff revealed that when R1 was hospitalized, they believed that R1 required a higher level of care and believed that the facility could not meet R1’s needs. Staff interviews revealed that R1 has had ongoing medical issues that require additional staffing needs and the facility questioned whether they could meet the need at that time. Whereas interviews and record review noted that R1 was allegedly cleared for discharge on 3/25/2022, the staff considered whether they would be able to accept R1 back in the facility. Hence, this delayed R1’s return to this facility. However, after further discussion, R1 was discharged and returned to the facility on 3/31/2022. R1 indicated that there has been no further mention of relocation. Staff are continuing to assess if they can meet R1’s needs at this time.

Based on the information obtained, there is insufficient evidence to support the claim, that facility staff is unlawfully evicting a resident while in care. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued. Jessica Munoz was authorized to sign the report. Assistant Administrator Janyce Pink was notified of the report.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

LIC9099 (FAS) - (06/04)

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