197603165-12-29-2025-29-AS-KHEN-DQPSBF-20260126124350

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 12/29/2025
Date Signed: 12/29/2025 03:29:00 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
11/24/2025 and conducted by Evaluator Quoc Huynh

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20251124083836

FACILITY NAME:	GLEN PARK AT VALLEY VILLAGE		FACILITY NUMBER:	197603165
ADMINISTRATOR:	VIRGINIA SUMULONG		FACILITY TYPE:	740
ADDRESS:	5527 LAUREL CANYON BLVD		TELEPHONE:	(818) 769-6626
CITY:	VALLEY VILLAGE	STATE:	ZIP CODE:	91607
CAPACITY:	100	CENSUS: 45	DATE:	12/29/2025
		UNANNOUNCED	TIME BEGAN:	01:04 PM
MET WITH:	Virginia Sumulong - Executive Director		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Resident was not accorded dignity and respect
Staff withheld food from Resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Quoc Huynh conducted a subsequent visit to deliver findings for the above allegations. The LPA arrived at 1:04PM and met with Interim Executive Director (ED) Virginia Sumulong. Entrance interview conducted.

On 12/01/2025, an initial visit was conducted. Between 10:18AM and 3:16PM, the LPA toured the physical plant, interviewed five (5) residents and five (5) staff, and reviewed and obtained pertinent documents.

During today’s visit, the LPA and ED conducted a physical plant tour and no immediate concerns were observed. The following was then determined:

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025

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-20251124083836

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: 12/29/2025

NARRATIVE

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Allegations: “Resident was not accorded dignity and respect” and “Staff withheld food from Resident”

It was reported that Staff #1 (S1) did not treat Resident #1 (R1) with respect and withheld food. Resident interviews revealed that S1 is generally respectful and has not been observed to yell. They reported that R1 often engages in conflict with staff, including following them around the facility and raising their voice. Residents noted that while R1 and S1 have daily disagreements, S1 typically responds by reminding R1 of facility policies. Residents also reported that they have not experienced food being withheld, even when arriving late to mealtimes. They indicated that when R1 arrives late, they sometimes request multiple meals at once, which can delay kitchen staff in completing other duties.

R1 expressed feeling that they must avoid conflict with S1 and stated that S1 treats other residents respectfully but not them. R1 was unable to provide specific examples of disrespectful language. R1 acknowledged calling staff derogatory names when upset and videotaping staff interactions. R1 reported being late to mealtimes due to their health condition and initially claimed food was refused, but later clarified that meals are provided, though preparation may take additional time.

Staff reported that R1 can be challenging to serve, often insisting on services according to their own preferences and timeline. Staff described R1 as frequently raising their voice and disregarding facility rules. Staff stated that S1 responds appropriately and does not yell at R1. S1 reported their role with R1 is limited to medication administration and that they do not engage further in R1’s behavior. Staff noted that R1’s videotaping of staff causes discomfort. Staff confirmed that although R1 is often late to meals, food is provided. Staff stated they anticipate R1’s tardiness and save meals or provide alternative options when necessary.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20251124083836

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: 12/29/2025

NARRATIVE

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Documentation indicated R1 has a diagnosis of Schizoaffective Disorder with mild cognitive impairment. The Appraisal/Needs and Services Plan dated 12/09/2024 noted periods of forgetfulness and non-compliance with dietary recommendations, with staff expected to provide reminders and simple instructions. R1’s Individual Program Plan (IPP) dated 06/02/2022 documented difficulty in understanding the consequences of actions, defensive reactions to feedback, and frequent arguments. The IPP noted disruptive behaviors interfering with social participation, with outburst occurring at least weekly, and included goals for R1 to work toward following facility rules and recommendations.

Although the allegations may have happened or are valid, there is insufficient evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed UNSUBSTANTIATED at this time.

The LPA discussed staff conduct and resident care needs with the ED to ensure continued understanding of resident behavior and appropriate staff responses. The ED acknowledged and understood.

No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 12/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/29/2025

LIC9099 (FAS) - (06/04)

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