197603165-6-7-2022-29-AS-JAPL-CFMNXE-20220622105058

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 06/07/2022
Date Signed: 06/07/2022 04:34:26 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
02/28/2022 and conducted by Evaluator Elsie Campos

COMPLAINT CONTROL NUMBER: 29-AS-20220228141307

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: 38	DATE:	06/07/2022
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Qwutaria Rogers-Office Manager		TIME COMPLETED:	04:40 PM

ALLEGATION(S):

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Facility staff member inappropriately handled resident's financial information.

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 Office Manager Qwutaria Rogers and explained the reason for the visit.

During the initial visit conducted on 3/8/2022, LPA Sandra Urena conducted a physical plant tour at 9:30 a.m., and interviewed staff at 9:50 a.m., 11:30 a.m., and interviewed Resident #1 (R1) at 10:30 a.m. During today’s visit, the LPA’s conducted a file audit from 1:50 p.m. – 2:10 p.m., conducted a physical plant tour at 1:40 p.m., interviewed residents at 2:20 p.m., 2:55 p.m., 3:01 p.m., 3:02 p.m., 3:05 p.m., 3:07 p.m. and 3:10 p.m., and interviewed staff at 2:42 p.m. and 3:18 p.m.

Continued on LIC 9099-C

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: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

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-20220228141307

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: 06/07/2022

NARRATIVE

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Allegation: Facility staff member inappropriately handled resident's financial information.

On 2/28/2022, the Department received a complaint which alleged that the facility was requesting Resident #1’s (R1) financial information such as their ID and demanding they verify pin information for the bank. During the visit on 3/8/2022 LPA Urena interviewed Staff (S1) and R1. S1 confirmed that they had assisted residents with filling out financial forms upon admission and will assist with ATM PIN numbers if residents request assistance. S1 denied claims that they have demanded any financial information or personal banking information from R1 or any resident. During today’s visit, the LPA’s interviewed staff and residents in which it was communicated that residents have not been asked or demanded to provide financial information. An additional interview with R1 further confirmed that no one here at the facility has handled their financial information inappropriately and believes that their monthly rent is paid through social security income.

Based on the information obtained, there is insufficient evidence to support the claim, that facility staff member inappropriately handled resident’s financial information. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie Campos	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2022

LIC9099 (FAS) - (06/04)

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