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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 05/22/2024
Date Signed: 05/24/2024 01:40:32 PM

Substantiated


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
08/14/2023 and conducted by Evaluator Zabel Chochian
COMPLAINT CONTROL NUMBER: 29-AS-20230814151148
FACILITY NAME:GLEN PARK AT VALLEY VILLAGEFACILITY NUMBER:
197603165
ADMINISTRATOR:TILLMAN PINKFACILITY TYPE:
740
ADDRESS:5527 LAUREL CANYON BLVDTELEPHONE:
(818) 769-6626
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:100CENSUS: 37DATE:
05/22/2024
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Marilou Mendoza, Administrator & Virgina Gigi Sumulong, Assistant AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has bed bugs
Facility is not safeguarding residents’ belongings
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to the facility. The purpose of the visit is to deliver investigation finding. Upon arrival LPA met with current Administrator Marilou Mendoza, and Virgina Gigi Sumulong the Assistant Administrator. Reason for the visit was explained. Entrance interview conducted.

On 08/14/2023, Community Care Licensing Division received the above complaint allegations. Investigation into the allegations consist of facility physical plant tour, interview with staff and residents on 08/16/2023. Following is a summary of the allegations and investigation finding:

Allegations) Facility has bed bugs and Facility is not safeguarding residents’ belongings – It was reported that the facility is not taking appropriate action to eradicate the bed bug issue. Furthermore, it was reported that the previous administrator Marhlyn Sapugay, put all the residents' clothes and personal belongings outside in the facility parking lot allowing public access to residents’ belongings. (Continue to LIC 9099c).
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
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 5
Control Number 29-AS-20230814151148
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: 05/22/2024
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
 To investigate this allegation on 08/16/2023 random resident rooms (#5, 6, 22, 23, 37) were toured. In addition, staff and random residents were interviewed. Staff reported that bed bugs are an ongoing issue at the facility due to residents bringing it in and refusing to shower or maintain room cleanliness. Staff reported that they do regular room checks and if any bed bug activity is noticed or reported by any resident the resident is moved to another room and the room is treated. Six out of six residents interviewed reported having bed bug activity in their room. It was confirmed through interviews with staff and previous administrator that resident rooms identified with bed bug activity were cleared and clients’ belongings were taken out and left in the open parking lot. Ms. Sapugay stated this action was taken to mitigate the bed bug issue identified in specific client rooms. Discussion was held with Ms. Sapugay regarding allegations, and Ms. Sapugay acknowledged that the action taken to eradicate the facility bed bug issue was not handled appropriate at the time.

Based on the information gathered allegations “Facility has bed bugs and Facility is not safeguarding residents’ belongings’” is deemed SUBSTANTIATED.

Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D). Exit interview and report reviewed with the Administrator. A copy of the report and appeal rights were issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20230814151148
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/28/2024
Section Cited
CCR
87468.1
1
2
3
4
5
6
7
Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Current Administrator stated that they have the pest control company assess the facility and all resident rooms for pest control. Ongoing service is provided. Administrator will provide invoice copies from 8/2023 to present. Also submit what steps have been taken to rectify the facility pest issues and
8
9
10
11
12
13
14
Based on interviews and observation, the facility did not provide residents a safe, healthful and comfortable accommodations, as bed bugs were observed and interviews confirmed bed bugs. This posed a potential health, safety, and personal rights risk to residents in care.
8
9
10
11
12
13
14
what actions will be taken to ensure facility is maintained free of pests.
Type B
05/28/2024
Section Cited
CCR
87217(b)
1
2
3
4
5
6
7
Safeguards for Resident Cash, Personal Property, and Valuables Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The current Administrator has agreed to do the following:
1. Submit a Plan of Action, detailing how the facility will ensure that resident personal property is safeguarded.

Submit plan to CCLD by 05/24/2024.
8
9
10
11
12
13
14
Based on the investigation, the licensee did not comply with the section cited above as it related to former administrator storing/leaving resident's belongings outside in the parking lot to get rid of bed bugs. This posed a potential personal rights risk to residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
08/14/2023 and conducted by Evaluator Zabel Chochian
COMPLAINT CONTROL NUMBER: 29-AS-20230814151148

FACILITY NAME:GLEN PARK AT VALLEY VILLAGEFACILITY NUMBER:
197603165
ADMINISTRATOR:TILLMAN PINKFACILITY TYPE:
740
ADDRESS:5527 LAUREL CANYON BLVDTELEPHONE:
(818) 769-6626
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:100CENSUS: 37DATE:
05/22/2024
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Marilou Mendoza, Administrator & Virgina Gigi Sumulong, Assistant AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility is not meeting clients’ needs:
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to the facility. The purpose of the visit is to deliver investigation finding. Upon arrival LPA met with and explained the reason for the visit. Entrance interview conducted. To

On 08/14/2023, Community Care Licensing Division received the above complaint allegations. Investigation into this allegation consist of facility physical plant tour, interview with staff and residents on 08/16/2023.

Following is a summary of the allegation above and investigation finding.

Allegation - Facility is not meeting clients’ needs – Information was received that staff are not taking initiative to address clients’ who refuse to shower and clean room. To investigate this allegation, on 08/16/2023 interviews were conducted with facility staff and random clients. Six (6) out of six (6) clients interviewed reported no issues or concern with staff meeting their needs. (Continue to LIC9099c).
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20230814151148
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: 05/22/2024
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
Clients reported that staff assist with medication, showers and clean their room when needed. No issues were reported. One client expressed that they are responsible for self and do not need staff to assist with care needs. Client expressed that if needed staff assist with daily activities. Client expressed they do not like to be bothered therefore refuse at times to be showered and have room cleaned. Client reported that staff do come by and offer to assist with shower and clean room however most of the time client refuses. Staff interviewed reported that most of the clients cooperate with care services being provided. According to staff if client refuses any services, it is document. Regarding client #1 staff reported that it is a great challenge getting client #1 to shower and having room cleaned. Staff reported that client #1 is very combative therefore staff are afraid to approach client #1. According to staff they have identified that client #1 will only allow specific staff to assist with care needs and cleaning. Therefore client #1 did recently agree to shower and have room clean. During initial visit LPA observed staff interact with client #1 and client agreed to have room cleaned.

Based on the above information gathered although the allegation may be valid, there is insufficient evidence to support the allegation or that a violation occurred; therefore, the allegation “Facility is not meeting client’s needs” is deemed unsubstantiated at this time.

Exit interview held. Copy of report provided.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel ChochianTELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5