<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 11/15/2022
Date Signed: 11/15/2022 04:13:38 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
06/14/2022 and conducted by Evaluator Elsie Campos
COMPLAINT CONTROL NUMBER: 29-AS-20220614160743
FACILITY NAME:GLEN PARK AT VALLEY VILLAGEFACILITY NUMBER:
197603165
ADMINISTRATOR:PINK TILLMANFACILITY TYPE:
740
ADDRESS:5527 LAUREL CANYON BLVDTELEPHONE:
(818) 769-6626
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:100CENSUS: 49DATE:
11/15/2022
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Jessyca Munoz and Joysie CallejasTIME COMPLETED:
04:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff hit resident
Staff pulled residents hair
Staff did not prevent another resident from physically abusing resident
Staff does not ensure that resident needs are met
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Elsie Campos arrived unannounced for a subsequent complaint visit. The LPA met with Receptionist Jessyca Munoz and explained the reason for the visit. Administrator was not available at the time of the visit and report was delivered to designated staff Joysie Callejas as Jessyca Munoz left for the day.

On 6/22/2022, the LPA reviewed documents at 2:40 p.m and interviewed residents at 3:35 p.m and 3:42 p.m. On 11/1/2022, the LPA returned to the facility and interviewed resident at 1:40 p.m and it was discovered that further investigation was required prior to issuing findings. During today's visit, the LPA returned to the facility to resolve the complaint allegations and interviewed staff at 11:26 a.m., 11:50 a.m. and 12:06 p.m. Interviewed residents at 12:00 p.m., 12:20 p.m. and 12:30 p.m.

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
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-20220614160743
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: 11/15/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation: Staff hit resident
It is alleged that staff hit Resident #1 (R1). R1 did not provide any details what staff hit them and confirmed in a conversation that staff have not hit R1. R1 reported that they lied and were mad when they made the allegation. Interviews with staff and residents further confirmed that they have not witnessed or seen anyone hit R1 or any other residents. Interviews with Residents did not reveal any concerns regarding staff hitting or staff treating them without dignity and respect. Staff indicated R1 can be ok on a good day. Staff interviews revealed that R1 has previously expressed to them that they are not treated good by staff due to their dissatisfaction with staff being unable to stay with them 24/7. Staff additionally denied claims that staff hit residents. Based on interviews there is insufficient evidence to determine whether this allegation may or may not have happened, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff pulled residents hair
It is alleged that staff pulled residents hair. Resident #1 (R1) did not provide any details what staff pulled their hair and confirmed in a conversation that staff have not pulled R1’s hair. R1 reported that they lied and were mad when they made the allegation. Interviews with staff and residents further confirmed that they have not witnessed or seen anyone’s hair pulled at the facility. Interviews with Residents did not reveal any concerns regarding staff pulling hair or staff treating them without dignity and respect. Staff indicated R1 can be ok on a good day. Staff interviews revealed that R1 has previously expressed to them that they are not treated good by staff due to their dissatisfaction with staff being unable to stay with them 24/7. Staff additionally denied claims that staff have pulled residents hair. Based on interviews there is insufficient evidence to determine whether this allegation may or may not have happened, this allegation is deemed Unsubstantiated at this time.

Continued on LIC 9099-C
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20220614160743
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: 11/15/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding the allegation: Staff did not prevent another resident from physically abusing resident
It is alleged that staff did not prevent another resident from physically abusing a resident. Resident #1 (R1) did not provide any details what resident physically abused them or what staff did not do to prevent that from happening. R1 reported that they lied and were mad when they made the allegation. Interviews with staff and residents further confirmed that they have not witnessed or seen anyone being physically abused at the facility. Interviews with Residents did not reveal any concerns regarding physical abuse. Staff indicated R1 can be ok on a good day. Staff interviews revealed that R1 has previously expressed to them that they are not treated good by staff due to their dissatisfaction with staff being unable to stay with them 24/7. Staff additionally denied claims that staff have not prevented another resident from physically abusing another resident as such incidents have not been witnessed or happened. Based on interviews there is insufficient evidence to determine whether this allegation may or may not have happened, this allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff does not ensure that resident needs are met


It is alleged that staff are not helping Resident #1 (R1). R1 did not provide any details what exact help they were referring too. Interviews revealed that staff help with cleaning, laundry, bathing. R1 is helped with showers twice a week and assisted with toileting whenever it is needed. Interviews with Residents did not reveal any concerns regarding hygiene needs being unmet and indicated that that they are helped when they request it. Staff indicated R1 has good and bad days that include R1 crying, screaming declining services such as showers and will pick and choose which caregivers to comply with. Staff indicated that they provide two showers a week to R1. Based on interviews, there is insufficient evidence to determine whether this allegation may or may not have happened, this allegation is deemed Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted. Report signed and delivered

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Elsie CamposTELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:

DATE: 11/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3