197603165-4-26-2024-29-AS-DPEA-D5PMNB-20240528094516

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 04/26/2024
Date Signed: 04/26/2024 02:30:12 PM

Substantiated

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
03/19/2024 and conducted by Evaluator Valeria Conway

COMPLAINT CONTROL NUMBER: 29-AS-20240319110021

FACILITY NAME:	GLEN PARK AT VALLEY VILLAGE		FACILITY NUMBER:	197603165
ADMINISTRATOR:	MARILOU MENDOZA		FACILITY TYPE:	740
ADDRESS:	5527 LAUREL CANYON BLVD		TELEPHONE:	(818) 769-6626
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	100	CENSUS: 37	DATE:	04/26/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Marilou /mendoza		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Illegal Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Valeria Conway conducted a subsequent complaint visit to the above noted facility. The purpose of the visit is to conclude an investigation initiated by LPA Peraldi on 03/27/2024. LPA met with Marilou Mendoza and explained the reason for the visit.

It was alleged that Resident #1 (R1) was issued an illegal eviction.

During the initial visit, LPA Peraldi conducted an interview with the Administrator at 11:19 a.m. At 11:26 a.m., the LPA requested copies of pertinent documents. At 11:48 a.m., the LPA, along with the Administrator conducted a brief physical plant tour. On 04/15/2024 LPA Conway reviewed the eviction letter submitted to R1 on 03/13/2024.

Continued on LIC9099-C

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024

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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Control Number 29-AS-20240319110021

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: 04/26/2024

NARRATIVE

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Continued from LIC 9099

Information gathered during the course of the investigation reflected that R1 was issued a 30-Day eviction notice on 03/13/2024, due to resident breaking house rules and being abusive towards staff and residents.

LPAs review of the eviction notice reflected that the eviction notice was not in compliance with Title 22 due to the eviction not containing specific facts to permit determination of the date, place, witnesses, and circumstances concerning the reasons for the eviction.

On 04/16/2024, LPA contacted facility administrator and notified that the eviction letter should be rescinded and re-issued with the required components. Based on the information gathered, the above allegation “illegal eviction” is deemed SUBSTANTIATED at this time.

Pursuant to Title 22, CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D).

Exit interview conducted. A copy of the report and appeal rights were issued.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240319110021

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/26/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/03/2024 Section Cited CCR 87224(d)	1 2 3 4 5 6 7	Eviction Procedures. (d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Administrator agreed to do the following: 1.Rescind the eviction notice within the next 24 hours. This must be done in writing. Submit proof to CCL by 05/03/2024 2.Create a valid eviction notice for R1 and submit the eviction notice to CCL for prior approval.
	8 9 10 11 12 13 14	Based on interviews, and record review, licensee did not meet with the section above by not including date, place, witnesses, and circumstances surrounding the concerns of the eviction, which causes a potential personal rights violation to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Valeria Conway	TELEPHONE: (818) 454-0485
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024

LIC9099 (FAS) - (06/04)

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