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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197603165
Report Date: 07/28/2026
Date Signed: 07/28/2026 11:55:14 AM

Document Has Been Signed on 07/28/2026 11:55 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 VILLAGEFACILITY NUMBER:
197603165
ADMINISTRATOR/
DIRECTOR:		VIRGINIA SUMULONGFACILITY TYPE:
740
ADDRESS:5527 LAUREL CANYON BLVDTELEPHONE:
(818) 769-6626
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY: 100CENSUS: 44DATE:
07/28/2026
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:00 AM
MET WITH:Virginia Sumulong - Interim Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Quoc Huynh conducted a Case Management visit to deliver findings for a self-reported sexual assault. The LPA arrived at 10AM and met with Executive Director (ED) Virginia Sumulong. Entrance interview conducted.

On 02/03/2026, the Department received a notification of an alleged staff on resident sexual assault that occurred on the evening of 01/30/2026. On 02/04/2026, LPA Huynh conducted a Case Management Incident visit. Between 10:32AM and 11:26AM, the LPA conducted a physical plant tour and obtained pertinent documents including facility camera footage.

On 02/17/2026, the Department received Complaint Control #29-AS-20260217151650 and on 02/18/2026, LPA Huynh conducted an initial complaint visit.

During today’s visit, the LPA and ED conducted a physical plant tour at 10:06AM, and no immediate concerns were observed. The following was then determined:

On the evening of 01/30/2026, it was reported that Resident #1 (R1) was sexually assaulted in their room by Staff #1 (S1). R1 provided consistent statements of the events to facility staff, law enforcement, and the Department. R1, who is non-ambulatory but able to communicate their needs, described being forcibly assaulted and threatened, and later reported the incident, prompting immediate law enforcement involvement.

Report Continued on LIC 809-C
Kristin Heffernan
Quoc Huynh
DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/28/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 07/28/2026
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Facility camera footage showed S1 entering and remaining in R1’s room during the time of the alleged incident, and DNA analysis confirmed that bodily fluids collected belonged to S1. While S1 initially denied the allegation, they later admitted to oral copulation but claimed it was consensual and attempted to discredit R1 by falsely stating R1 had dementia. Staff interviews revealed no additional abuse concerns but documented S1’s history of poor performance and unreliability. Considering R1’s consistent statements, corroborating video footage, forensic evidence, and S1’s conflicting accounts, the evidence supported the allegation. A citation was issued via report for Complaint Control #29-AS-20260217151650.

Throughout the course of the investigation, it was noted that the facility did not report the sexual assault to the Department in a timely manner. Per reporting requirements, physical abuse that does not result in serious bodily injury shall be reported to the Ombudsman, the Department, and local law enforcement within twenty-four (24) hours. The sexual assault occurred on 01/30/2026 and reported to staff on 01/31/2026. Staff responded by notifying the ED and law enforcement which prompted the ED to visit the facility. The Department received notification approximately three (3) days after the discovery of the incident, on 02/03/2026. Interview with the ED and Office Manager (OM) revealed that the events surrounding the incident occurred on a weekend and both the ED and OM were not scheduled to work. Additionally, there was miscommunication on the placement of the incident report for the ED’s approval which resulted in the delay.

Pursuant to Title 22 CA Code of regulations and/or the Health and Safety Code, the following deficiency was cited (Refer to LIC 809-D).

Exit interview conducted. A copy of the appeal rights and report was reviewed and provided.
NAME OF LICENSING PROGRAM MANAGER: Kristin Heffernan
NAME OF LICENSING PROGRAM ANALYST: Quoc Huynh
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/28/2026 11:55 AM - It Cannot Be Edited


Created By: Quoc Huynh On 07/28/2026 at 10:31 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT VALLEY VILLAGE
FACILITY NUMBER: 197603165

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/28/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2026
Section Cited
CCR
87211(c)

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(c) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported… within twenty-four (24) hours as required by Welfare and Institutions Code Section 15630(b)(1).

This requirement was not met as evidenced by:
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The Licensee will review reporting requirements and submit a statement of understanding to CCLD by POC due date.
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Based on record review, the Licensee did not comply with the above cited section as the Department did not receive notification of R1’s sexual abuse within 24 hours which poses a potential health, safety, and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kristin Heffernan
NAME OF LICENSING PROGRAM MANAGER:
Quoc Huynh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/28/2026


LIC809 (FAS) - (06/04)
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