197608505-3-23-2022-28-AS-FFIS-CD4335-20220401175255

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 03/23/2022
Date Signed: 03/23/2022 05:12:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/17/2019 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20191217093514

FACILITY NAME:	GLEN PARK AT GLENDALE - BOYNTON ST		FACILITY NUMBER:	197608505
ADMINISTRATOR:	PINK, JR, TILLMAN		FACILITY TYPE:	740
ADDRESS:	1250 BOYNTON ST		TELEPHONE:	(818) 246-9000
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	98	CENSUS: 69	DATE:	03/23/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Yamilex Razo, Executive Director/ Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident's care needs were not being met resulting in hospitalization.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Tao conducted an unannounced subsequent visit to this facility. LPA met with Yamilex Razo, Administrator. LPA explained the purpose of today’s visit is to discuss the above mentioned allegation.

LPA conducted an initial visit on 12/20/19 and subsequent visits on 06/23/21, 12/23/21 and 3/23/22. During today's visit, LPA obtained staff roster and resident roster. LPA interviewed Staff# 5 and attempted to interview Resident#13. LPA reviewed resident files and incident reports for resident #1 (R1).

The investigation consisted of resident interview, staff interview, record reviews and observation. In regard to allegation “Resident's care needs were not being met resulting in hospitalization," it was alleged that resident was admitted to the hospital and the hospital found out resident had scabies, fungal infection, a urinary tract infection (UTI) and dehydration. (-Continued on LIC 9099-C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022

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 28-AS-20191217093514

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT GLENDALE - BOYNTON ST	FACILITY NUMBER: 197608505
	VISIT DATE: 03/23/2022

NARRATIVE

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Resident interviews revealed that eight (8) out of ten (10) residents denied of having scabies and had no knowledge about it. One (1) out of ten (10) resident had fungus issue and had received medical care from facility. One (1) out of ten (10) resident had scabies in 2020 and facility provided care to resident per doctor prescription and incident report was filed to Licensing. Nine (9) out of ten (10) residents denied of having UTI and had no knowledge about it. One (1) out of ten (10) resident had UTI. Resident with UTI received care from staff and staff prompted resident to have fluid intake on a 2-hour check. Nine (9) out of ten (10) residents denied of having change of condition and had no knowledge about it. One (1) out of ten (10) resident had change of condition. Resident stated additional daily living assistance (ADL) was provided as resident’s need. Ten (10) out of ten (10) residents stated they have enough fluid intake. Drink water was provided at the facility’s common area and residents’ room throughout the day. Four (4) out of ten (10) residents stated staff would prompt residents to drink water and / or bring water to residents during the day.

Staff interviews revealed that two (2) out of seven (7) staff knew resident #1 had scabies. Five (5) out of seven (7) staff were not acknowledged of resident #1 who had scabies. All seven (7) staff interviews reviewed that staff would take precautions to prevent the spread of scabies when working with residents with scabies. Facility would have resident with scabies quarantined in resident’s room for a week, bed sheets and laundry were washed daily in hot water which would washed separately from other resident’s laundry, resident’s room was cleaned daily, and staff needed to put on personal protection equipment (PPE) before assisting resident with scabies. Three (3) out of seven (7) staff stated scabies and UTI medication were administered as physician’s prescribed. Four (4) out of seven (7) staff stated they had no knowledge about resident’s medication. All seven (7) out of seven (7) staff stated they did not aware of resident had any change of condition. Staff stated that they would report to administrator if staff observed any change of condition from residents. Six (6) out of seven (7) staff stated they offered fluid to resident to keep resident hydrated. One (1) out of seven (7) staff had no knowledge about resident#1’s fluid intake. Staff provided water, milk, juice and tea to resident during breakfast, lunch, and dinner. Water was provided during medication time. Facility provided a pitcher of water to each resident’s room and a water machine was available in the common area. Staff would prompt resident to drink water or serve water to resident if needed. Three (3) out of seven (7) staff were aware of resident #1 had UTI and UTI medication was dispensed as physician described. Four (4) out of seven (7) staff were not acknowledged of resident #1 having UTI. All seven (7) staff interviews reviewed that staff would check on resident every two hours. (-Continued on LIC 9099-C-)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20191217093514

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT GLENDALE - BOYNTON ST	FACILITY NUMBER: 197608505
	VISIT DATE: 03/23/2022

NARRATIVE

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On the 2-hour check, staff assisted resident on the use of bathroom, change diapers and check fluid intake. Per record review, facility had provided in-service training to staff on taking care of resident with scabies, dementia, change of condition, and UTI. Per LPA’s observation, drinking water was provided in the common area. Staff passed water pitchers into resident’s room. One resident was drinking a glass of water at the lobby. Incident report regarding resident’s scabies was filed to Licensing. LPA did not observe resident’s care needs were not being met resulting in hospitalization. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Administrator, Yamilex Razo, and a hard copy was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 03/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022

LIC9099 (FAS) - (06/04)

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