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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 01/30/2021
Date Signed: 01/30/2021 11:49:48 AM



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
01/23/2020 and conducted by Evaluator Wendell Smith
COMPLAINT CONTROL NUMBER: 31-AS-20200123160902
FACILITY NAME:GLEN PARK AT VALLEY VILLAGEFACILITY NUMBER:
197603165
ADMINISTRATOR:PINK, JR, TILLMANFACILITY TYPE:
740
ADDRESS:5527 LAUREL CANYON BLVDTELEPHONE:
(818) 769-6626
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:100CENSUS: 45DATE:
01/30/2021
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Marcela Higuera (Receptionist)TIME COMPLETED:
11:50 AM
ALLEGATION(S):
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Illegal eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Wendell Smith finished a complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Marcela Higuera.
Regarding the allegation above it is alleged that resident #1 (R1) was illegally evicted from the facility. Interviews were conducted with the current administrator at the time, facility staff, and R1's conservator. Information from interviews reveal that R1 was supposedly given a thirty day eviction on 12/31/2019 which R1's conservator refused to receive so a copy was sent certified mail to R1's conservator's address and it was refused at that time. On 1/16/2020 there was an incident at the facility with R1 where law enforcement was involved and R1 had to leave the facility and was taken to the police station. Facility spoke with R1 and R1's conservator and it was arranged for R1 to pick up their belongings on either 1/20/2020 or 1/21/2020. Based on the information obtained through interviews there is not enough information to state that R1 was refused entry back to the facility on 1/16/2020 or due to the pending eviction did not come back to the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2021
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 2
Control Number 31-AS-20200123160902
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: 01/30/2021
NARRATIVE
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LPA was able to review a copy of the eviction and it was deemed lawful by the Woodland Hills Regional Office. It was received in the Woodland Hills Regional Office on 1/2/2020. Based on the information obtained through interviews this allegation is deemed Unsubstantiated at this time. There is not enough information to state that R1 was illegally evicted. Exit Interview conducted. Copy of report emailed for signature.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell SmithTELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:

DATE: 01/30/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2