197603165-9-15-2021-31-AS-NGID-C7CKCB-20210930074650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 09/15/2021
Date Signed: 09/15/2021 12:42:39 PM

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
01/24/2020 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20200124103238

FACILITY NAME:	GLEN PARK AT VALLEY VILLAGE		FACILITY NUMBER:	197603165
ADMINISTRATOR:	PINK, JR, 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:	09/15/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Elizabeth Torres		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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9

Staff denied residents phone calls
Staff did not provide resident with his mail

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent complaint visit to gather more information related to the investigation of the allegations above. LPA conducted previous visits to investigate the allegations above and a finding of Unsubstantiated was rendered but after further review more information was needed to complete the investigation into the allegations above. LPA met with facility staff and explained the reason for this visit.
Regarding the allegations above it is alleged that staff have denied residents phone calls and was not providing residents with their mail. From approximately 9:45-10:15am, LPA conducted interviews with random residents regarding both of these allegations. During the visit LPA witnessed mail being placed in resident's mailboxes. Based on the information obtained through interviews and observation both allegations are still Unsubstantiated. No deficiencies cited. Exit Interview conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 09/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2021

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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