197603165-9-18-2024-29-AS-KLOZ-DBE94D-20241126220209

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 09/18/2024
Date Signed: 09/18/2024 06:46:50 PM

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
09/17/2024 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20240917113114

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: 41	DATE:	09/18/2024
		UNANNOUNCED	TIME BEGAN:	01:39 PM
MET WITH:	David Aguiniga		TIME COMPLETED:	06:50 PM

ALLEGATION(S):

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Staff are not notifying residents of COVID outbreak.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted an initial 10-day visit to investigate the allegation listed above. The LPA met with Executive Director (ED) David Aguiniga and Assistant Administrator (AA) Virginia Sumulong informed them of the reason for the visit. At 1:45 p.m., LPA Urena requested records pertinent to the investigation, and conducted administrators, staff and residents’ interviews from 2:00 p.m. to 5:30 p.m.
Staff are not notifying residents of COVID outbreak.
On the allegation that staff are not notifying residents of a COVID outbreak, it is the concern of the reporting party (RP) that staff are not notifying residents of the cases of COVID at the facility or conducting COVID testing. Per the RP, one staff had COVID (although the staff did not know they were COVID positive); however, the staff was in contact with residents. Additionally, the RP stated that they knew that three residents were also COVID positive but did not know the name of two of the residents. To investigate the allegation, LPA Urena interviewed administrators, staff and residents about the allegation.
Continues on LIC 9099C...

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: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

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-20240917113114

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: 09/18/2024

NARRATIVE

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The Administrators interviews revealed that there were three residents COVID cases, and one staff case in the past three weeks. The first two cases were during the first week of September, and the third case was confirmed on 09/12/2024. Initial and follow up COVID testing was done for the one resident. The follow up test showed negative for COVID. The resident was isolated during the six-day wait period between the initial and the follow-up COVID testing. Staff was tested by their health provider and were off work during the infectious period. The ED stated that they informed the residents about the COVID cases during the lunch time while residents were in the dining room. Furthermore, the ED stated that residents were told that if they wanted a mask, that the masks were available at the front desk. The ED also stated that they told the residents that facility staff could not force residents to wear the mask, but residents were highly encouraged to wear the mask. The ED stated that they did not inform residents in writing, only verbally, however they did post the quarantine notice on the COVID positive residents’ door as well as the PPE equipment outside the residents’ doors. The Administrator denied telling the RP that “they are not telling anyone or not doing testing”. Residents’ interviews revealed that some residents were in the dining room when the ED told them about the COVID positive cases and about the masks being available at the front office. Other residents stated that they saw the quarantine notices posted on the residents’ doors, and other residents stated that they were tested and came out with negative results for COVID. During the physical plant walk, the LPA observed the PPE COVID equipment still placed outside the last resident who tested COVID positive. Furthermore, the LPA noticed paper notices taped to each one of the residents’ bedrooms doors about a Vaccination Clinic (COVID, Flu, Shingles, Pneumonia, and RSV) being offered at the facility on 09/20/2024.

Although the administrative staff did not send written notices to residents about the COVID cases, the administrative staff verbally informed residents and staff about the positive COVID cases and offered to mitigate the spread of COVID by offering PPE equipment. Based on the information obtained through interviews and record review, there is insufficient evidence to support the allegation that staff did not inform residents about the COVID positive cases. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview was conducted and 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: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC9099 (FAS) - (06/04)

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