197603165-10-12-2023-29-AS-KLOZ-CX5SN7-20231031140104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 09/29/2023
Date Signed: 10/12/2023 07:51:37 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
03/10/2021 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20210310091929

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: 44	DATE:	09/29/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Molly Ayala		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Licensee falsified residents' cash resource records.
Resident cash resources were commingled with the facility funds.

INVESTIGATION FINDINGS:

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This is an amended report to correct the dates of the initial 10-day visit by LPA Basili, and the complainant's interview.
Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced subsequent visit to deliver the findings for the allegations above. The LPA arrived at 10:00 a.m., met with Molly Ayala, LVN, the facility representative, and explained the reason for the visit.
On 03/15/2021, Licensing Program Analyst (LPA) Brian Balisi initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, the complaint investigation visit was conducted telephonically at 11:00am with Elizabeth Flores, the facility Assistant Administrator. Between 12:30pm – 1:00pm, LPA Basili conducted telephone interviews with the administrator and a video call which consisted of a review of the physical plant. LPA also requested copies of census, staff schedule, admission agreement and resident documentation relevant to the investigation to be emailed to the LPA by end of business day. On 03/12/2021, LPA Basili interviewed the complainant at 11:15 a.m. Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

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-20210310091929

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT VALLEY VILLAGE	FACILITY NUMBER: 197603165
	VISIT DATE: 09/29/2023

NARRATIVE

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Licensee falsified residents' cash resource records.

On the allegation that the licensee falsified residents’ cash resource records; it is the reporting party’s concern that some residents had their Personal and Incidental Needs allowance (P&I) records falsified by staff. It was alleged that staff would write down that the residents received more money than what was given to them. A financial audit was conducted, and a final audit report was completed on 08/29/2023. The audit review revealed that the documentation submitted by the facility and reviewed by the auditor, disclosed that the facility provided “petty cash” receipts to the residents. However, the facility’s cash handling policy and procedures described that, residents are to sign for their deposits and withdrawal on ledgers (LIC 405). Additionally, residents’ signature/initials were not found on the ledgers, only the accounting personnel typed initials were observed on the ledgers. This system does not allow for the resident to acknowledge their balance, which include deposits and withdrawal amounts. Residents should be able to see their ledger amounts to ensure they are free of error and deposits are entered in a timely manner. Residents were asked to sign the individual “petty cash slips” which do not allow the residents to be aware of the total amount they have and how much is credited/debited each month. Although the facility’s cash resource records were not documented appropriately, there is insufficient evidence to prove that the records were falsified.

Based on the information obtained and reviewed, and although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur. Therefore, the allegation is deemed Unsubstantiated at this time.

Resident cash resources were commingled with the facility funds.

On the allegation that cash resources were commingled with the facility funds; it is the reporting party’s concern that the facility is mixing residents' Personal and Incidental Needs allowance (P&I) with staff’s payroll. The complaint was referred to the Community Care Licensing Audit Department. A financial audit was conducted, and an audit report was completed on 08/29/2023. The audit review revealed that all the checks for P&I were from the residents’ trust account.

Continues on LIC9099 C- page 3...

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20210310091929

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT VALLEY VILLAGE	FACILITY NUMBER: 197603165
	VISIT DATE: 09/29/2023

NARRATIVE

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Glen Park has a Trust Account to save and manage the personal and incidental cash the residents receive from various sources, the most common source being from family members or Social Security benefits, especially for those individuals needing assistance in managing their finances. Each facility has two Trust Accounts: one account for Regional Center residents and a second account for Social Security beneficiaries. Though the licensee kept the residents’ cash in the two trust accounts, their actual practice of having residents sign the “petty cash slip” made this process look like they were commingling residents’ funds with facility’s petty cash.

After further investigation, it was noted that the facility has kept an inaccurate receipt for cash. However, no commingling of cash resources was noted. Therefore, the allegation is deemed Unsubstantiated at this time.

An exit interview was conducted with facility representative. A copy of the report was issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC9099 (FAS) - (06/04)

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