197603165-4-4-2024-29-AS-KLOZ-D9GPBL-20240926111028

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 04/03/2024
Date Signed: 04/04/2024 08:21:08 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
05/08/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230508154924

FACILITY NAME:	GLEN PARK AT VALLEY VILLAGE		FACILITY NUMBER:	197603165
ADMINISTRATOR:	TILLMAN PINK		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:	04/03/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Marylou V. Mendoza		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Staff refuse to let residents leave the facility.
Staff tie/lock up resident doors.
Residents in care are denied food.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent complaint unannounced visit to investigate the allegations listed above. LPA Urena met with Executive Director (ED) Marylou V. Mendoza and Assistant Administrator (AA) Virginia Sumulong, and explained the reason for the visit.
On 05/09/2023, Licensing Program Analyst (LPA) Angel Ascencio conducted an initial 10-day complaint. LPA Ascencio met with Interim Administrator Rafael Silva at 10:08 a.m. Entrance interview conducted. During the visit, LPA Ascencio reviewed staff files at 11:00 a.m. and obtained pertinent documents. LPA Ascencio advised Interim Administrator Silva that the allegation of Personal Rights has been referred to the Department's Investigation Branch (IB) for further review.

On 04/03/2024, at 11:05 a.m. LPA Urena requested additional records pertinent to the investigation, and at 11:20 a.m. the LPA interviewed the ED and the AA. At 12:15 p.m., the LPA observed lunch in the dining room and conducted residents’ interviews and staff interviews from 12:21 p.m to 2:30 p.m.

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: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

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 4

Control Number 29-AS-20230508154924

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: 04/03/2024

NARRATIVE

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Page 2.
Staff tie/lock up resident doors.
It is the concern of the Reporting Party(s) (RP) that staff are tying the doors up, so they cannot be opened by residents. LPA Urena interviewed staff and residents about front doors being tied up or locked. The ED and AA interviews revealed that the front doors are never locked/tied from the inside. However, the front doors are locked from the outside. Visitors must be buzzed in, and residents have the code to the front doors to gain access into the building. If the resident does not have the code, they get buzzed in. Five out of six residents’ interviews revealed that they have not experienced, nor have witnessed the front doors being tied up. One resident stated that they have experienced in the past, the front door being locked, but when they asked the front desk staff to unlock it, the door was unlocked. The resident added that they understood why it was locked at that time. The resident went on to explain that there are residents who may experience dementia and try to leave the building, and given the busy street and the traffic outdoors, the door was locked for their safety.

Based on the information obtained through interviews, the allegation that staff tie/lock the residents’ doors is deemed Unsubstantiated at this time.

Staff refuse to let residents leave the facility.

It is the concern of the Reporting Party(s) (RP) that staff refuse to let residents leave the building by illegally locking facility doors at night, so residents are trapped in the facility. The ED and AA interviews revealed that the front doors are never locked from the inside. However, the front doors are locked from the outside. Six out of six residents’ interviews revealed that they have not experienced, nor have witnessed the front doors being locked at night. One resident stated that sometimes they hear commotion, when transients are pounding on the front doors trying to get in the building. The resident stated that they are glad the doors are locked from the outside for the safety of the residents.

Based on the information obtained through interviews, the allegation that staff refuse to let residents leave the facility is deemed Unsubstantiated at this time.

Continues on pg. 3

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230508154924

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: 04/03/2024

NARRATIVE

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Page 3.
Residents in care are denied food.
On the allegation that residents are denied food, the RP(s) only stated that residents are being denied food. To investigate the allegation, the LPA observed lunch time at approximately 12:15 p.m. The LPA observed approximately fifteen (15) residents in the dining room, either eating on their own or residents were being fed by staff. Per the staff interviews, some of the residents were in an outing and took lunch bags; additionally four (4) residents receive their meals served in their room due to being bed bound. The interview with the ED, and the AA revealed that the residents either eat in the dining room or in their room. Some may eat in their room due to being ill and not able to go to the dining room, or due to being bed bound. Six out of six residents interviewed revealed that they have not been denied food, however one resident reported that when they ask for additional liquids/different meal, staff may say ‘wait, wait’. One resident stated that residents are given the menu on a monthly basis, and that if residents wish to make a specific meal request, the resident must write it down on a request slip prior to meal being served, preferably the day before, and give the request slip to the front desk staff, who then gives it to the to the chef assistant. The special meal request is then prepared and provided to the residents. The AA provided a copy of the menu for the month of April to the LPA. The LPA was able to review, compare and confirm the menu meal, as it was served during today’s lunch time.

Based on the information received through interviews, and observation, the residents are being provided with meals that are reflected in the monthly menu. Therefore, the allegation that Residents in care are denied food, is deemed Unsubstantiated at this time.

Exit interview was conducted. 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: 04/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2024

LIC9099 (FAS) - (06/04)

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