197603165-7-2-2021-31-AS-NGID-C7CKCC-20210930074650

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 02/17/2021
Date Signed: 07/02/2021 03:55:50 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 Martina Berry

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: 45	DATE:	02/17/2021
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Elizabeth Flores		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff did not properly dispose of expired medication

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Martina Berry completed 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 facility Administrator Elizabeth Flores. The LPA met with the administrator and explained the reason for the visit.

To investigate this allegation, the LPA conducted interviews with staff on 2/11/21 and 2/16/21. The LPA reviewed the medication log and desctruction record for R1 on 2/9/21. The LPA also interviewed R1 on 2/16/21. Information received from interviews and file review revealed that R1 is on a fixed medication schedule. Medication travels with R1 during any time of hospitalization. There has been no need to destroy medication as R1 takes medication regularly. R1 has no concerns about medication services. Based on the information obtained, this allegation is unsubstantiated. No deficiencies cited. An exit interview was conducted with Administrator Elizabeth Flores and a copy of this report was provided via email for signature.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Martina Berry	TELEPHONE: (661) 361-6007
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021

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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