197603165-9-18-2024-29-AS-KLOZ-DBE8TN-20241126214814

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 09/18/2024
Date Signed: 09/18/2024 05:22:32 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
09/03/2024 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20240903161533

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:	01:34 PM
MET WITH:	David Aguiniga		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Staff does not provide safe environment for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent 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.

On 09/04/2024, Licensing Program Analyst (LPA) Sandra Urena conducted an initial 10-day visit to investigate the allegation listed above. The LPA arrived at 1:35 p.m., met Executive Director (ED) David Aguiniga and informed of the reason for the visit. At 1:45 p.m., LPA Urena requested records pertinent to the investigation, and interviewed the ED at 2:30 p.m. The complaint needs further investigation.

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-20240903161533

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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Staff does not provide safe environment for resident.

On the allegation that staff do not provide a safe environment for resident, it is the reporting party’s (RP) concern that resident (R1) does not feel safe at the facility. The RP did not elaborate in the complaint report as to why R1 does not feel safe. To investigate the allegation, on 09/03/2024 LPA Urena attempted to interview the RP, but RP did not return phone calls. On 09/03/2024, LPA attempted to interview R1’s acquaintances but was unable to communicate with them and leave a message. On 09/18/2024, the LPA introduced themselves to R1 and attempted to interview them privately, however, R1 refused the interview by saying that they did not want to speak. LPA tried to explain to R1 the reason for the visit and the interview and told R1 that they could stop the interview at any time they did not feel comfortable, but R1 continue to say they did not want to speak to the LPA. On 09/04/2024, the LPA interviewed the ED. The ED stated that R1 was admitted at the end of July 2024, and that R1 has complained since day one that staff do not like them and give R1 attitude with facial expressions, however R1 cannot say specifically to the ED, how staff are abusive. The LPA interviewed staff and the interview revealed that R1 has a tendency to get quickly irritated if they don’t immediately get what they ask for. The staff stated that on 09/01/2024, R1 called law enforcement and EMT because their breakfast was delayed.

Based on the information obtained through interviews and record review, there is insufficient evidence to support the allegation that staff do not provide a safe environment for resident in care. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview was conducted and 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: 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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