197603165-2-5-2021-31-AS-NGID-C7CKCD-20210930074651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 02/05/2021
Date Signed: 02/05/2021 01:01:45 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

PUBLIC

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: 43	DATE:	02/05/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Elizabeth Flores (Assistant Administrator)		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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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 finished a complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Elizabeth Flores.

Staff denied residents phone calls
It is alleged that resident #1 (R1) was not allowed to phone calls while in the facility. A previous visit was conducted on 1/28/2020 by LPA Manya Lefian regarding this allegation. Interviews were conducted with facility staff and R1's responsible person during this visit. LPA attempted to interview R1 but was unable to due to R1 not being at the facility at this time. LPA found where R1 has been relocated to for the time being and still was not able to interview R1. Information from interviews that were conducted found that there is not enough information to state that R1 was prevented from making phone calls when this allegation was alleged on 1/24/2020. Therefore this allegation is deemed Unsubstantiated at this time.

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: 02/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021

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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Control Number 31-AS-20200124103238

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: GLEN PARK AT VALLEY VILLAGE	FACILITY NUMBER: 197603165
	VISIT DATE: 02/05/2021

NARRATIVE

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Staff did not provide resident with his mail
It is alleged that staff did not provide R1 with his mail. A previous visit was conducted on 1/28/2020 by LPA Manya Lefian regarding this allegation. R1 was not able to be interviewed regarding this allegation despite separate attempts to interview R1. Interviews were previously conducted with facility staff and R1's responsible person. Based on information obtained through interviews there is not enough information to state that R1 was not provided with their mail.
Exit Interview conducted. Copy of report emailed for signature.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Wendell Smith	TELEPHONE: (818) 738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2021

LIC9099 (FAS) - (06/04)

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