197608505-3-24-2022-28-AS-LHIS-CEHF5T-20220517041140

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 03/24/2022
Date Signed: 03/24/2022 08:46:05 PM

Unsubstantiated

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
03/17/2022 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220317084812

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:	03/24/2022
		UNANNOUNCED	TIME BEGAN:	02:10 PM
MET WITH:	Yamilex Razo		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Unqualified staff providing care to residents
Staff are not meeting residents hygiene needs
Staff are not providing adequate food service for residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint visit in response to the above allegations. LPA met with Administrator, Yamilex Razo who assisted with today's visit.

Regarding the allegation that unqualified staff are providing care to residents, the investigation consisted of review of staff schedule, review of staff trainings, interview(s) with resident #1- #7, and Interview(s) with Administrator and Staff #1- #4. The investigation revealed the following: Residents interviewed were unable to corroborate the allegation. 6 out of 7 residents stated that the facility has sufficient, qualified staff providing care to residents. Administrator and staff interviewed were unable to corroborate the allegation, they stated that there are usually 3 to 4 caregivers during the morning shift, and during the afternoon shift. 4 out of 5 staff stated that the facility staff is qualified and providing sufficient care to residents. LPA observed that staff schedule reflected the information that was provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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-20220317084812

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: 03/24/2022

NARRATIVE

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Regarding the allegation that staff are not meeting residents hygiene needs, the investigation consisted of review of facility bathing schedule and interviews with Resident #1- #7, and interviews with Administrator and Staff #1- #4.

The investigation revealed the following : Residents' interviewed were unable to corroborate the allegation.
Residents interviewed, stated the following: 3 out of 7 residents stated they do not require assistance with their hygiene needs. 4 out of 7 residents, stated they are satisfied with the assistance they are receiving. Administrator and staff interviewed were unable to corroborate the allegation. 4 out of 5 staff interviewed stated that staff are meeting residents' hygiene needs. Review of bathing schedule indicates that residents who require assistance are getting assistance with their hygiene needs 2-3 times per week.

Regarding the allegation that staff are not providing adequate food service for residents, the investigation consisted of tour of kitchen, including perishable and non-perishable food supply, review of facility menu, and interviews with Resident #1- #7, and interviews with Administrator and Staff #1- #4. The investigation revealed the following: LPA observed a sufficient amount of perishable and non-perishable food supply on today's visit. Residents interviewed were unable to corroborate the allegation. 7 out of 7 residents stated that staff are providing adequate food service to residents. Administrator and staff interviewed were unable to corroborate the allegation, 4 out of 5 staff stated that staff are providing adequate food service to residents.

Based on LPA's observations and interviews, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Administrator, Yamilex Razo.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC9099 (FAS) - (06/04)

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