197603165-1-8-2026-29-AS-KHEN-DQPV4B-20260126150603

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603165
Report Date: 01/08/2026
Date Signed: 01/08/2026 02:05:27 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
12/22/2025 and conducted by Evaluator Quoc Huynh

COMPLAINT CONTROL NUMBER: 29-AS-20251222151805

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: CA	ZIP CODE:	91607
CAPACITY:	100	CENSUS: 46	DATE:	01/08/2026
		UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	Virginia Sumulong - Executive Director		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not safeguard resident’s personal items
Resident was not accorded dignity and respect in their personal relationships with staff

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Quoc Huynh conducted a subsequent complaint visit to deliver findings for the above allegations. The LPA arrived at 9:16AM and met with Interim Executive Director (ED) Virginia Sumulong. Entrance interview conducted.

On 12/29/2025, LPA Huynh conducted an initial visit. Between 1:19PM and 2:30PM, the LPA conducted a physical plant tour, interviewed one (1) resident and five (5) staff, and reviewed and obtained pertinent documents.

During today’s visit, the LPA and ED conducted a physical tour at 9:28AM 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: 01/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 29-AS-20251222151805

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: 01/08/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegations: “Staff did not safeguard resident’s personal items” and “Resident was not accorded dignity and respect in their personal relationships with staff”

It was reported that facility staff entered Resident #1’s (R1) room without permission and subsequently rearranged and removed R1’s personal items. Interview with R1 revealed that they observed one (1) item that was moved from their closet to the bed. R1 also confirmed that no personal items were missing or removed from their room. R1 initially reported wanting staff to communicate the reason for entering their room and to explain what they were doing while completing tasks. Later, R1 then stated they did not want staff to speak or communicate with them.

Interviews with staff indicated that they treat R1 with respect and provide constant communication with R1 while performing care tasks. Staff reported that R1 keeps numerous personal items that obstruct their ability to provide direct care. When staff request to temporarily move the personal items, R1 often refuses and also declines daily housekeeping services. Staff stated they are aware that R1 does not want their belongings touched and therefore avoid doing so without permission. Staff also reported they have not observed other staff or residents entering R1’s room without their permission or knowledge.

R1’s Appraisal/Needs and Services Plan dated 05/08/2025 and Individual Service Plan dated 06/20/2025 documented that R1’s living environment must remain safe and secure, with staff conducting regular safety assessments to prevent falls. The plans indicated that direct care staff maintain a clutter-free environment by removing potential hazards such as cords and spills.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20251222151805

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: 01/08/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

LPA Huynh observed that R1’s room contained multiple large boxes overflowing into the roommate’s side of the room, as well as food, miscellaneous trash, and power cords scattered on and under R1’s bed. When the LPA addressed these items, R1 stated that they needed these items and did not want staff to touch them. During today’s visit, staff and the ED informed the LPA of ongoing safety concerns in R1’s room and R1’s refusal to allow staff to assist with cleaning. The LPA explained the safety risks to R1 and requested that they allow staff to assist them. R1 then complied.

Based on interview, record review, and observation, R1 provided inconsistent statements and confirmed personal belongings were not missing. Additionally, staff assistance was consistent with R1’s care plan and focused on safety measures. 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.

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: 01/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/08/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3