197608505-5-20-2022-28-AS-SCOL-CF8P63-20220609110140

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 05/20/2022
Date Signed: 05/20/2022 02:06:15 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
03/21/2022 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220321083017

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: 68	DATE:	05/20/2022
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Yamilex Razo - Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Residents are not showered timely
Residents are not being shaved timely
Resident call buttons are not answered timely
Residents are not being changed timely

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced subsequent complaint visit to determine the validity of the above-mentioned allegation. LPA met with Administrator Yamilex Razo and explained the reason for the visit.

The investigation consisted of the following: On 03/28/2022, LPA obtained copies of resident and staff rosters, March 2022 staff work schedule and shower schedule/log. Conducted a facility tour. Interviewed the Administrator, Staff 1 - Staff 4 (S1 - S4), and Resident 1 – Resident 7 (R1 – R7). On today's visit, LPA obtained copies of resident and staff rosters, April and May 2022 staff work schedule and shower schedule/log, and interviewed Staff 5 - Staff 7 (S5 - S7).

The investigation revealed the following: regarding the allegations "residents are not showered timely", "residents are not being shaved timely", "resident call buttons are not answered timely" and "residents are not being changed timely", it is alleged that there is only 2 caregivers on shifts to meet the needs of 70 residents. (CONTINUED TO LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

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-20220321083017

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: 05/20/2022

NARRATIVE

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Residents interviewed were unable to corroborate with the allegations. All seven residents interviewed stated that there is enough staff to meet all their needs in a timely manner. Administrator and staff interviewed were unable to corroborate with the allegations. Five out of eight staff interviewed stated that there is enough staff, usually 4 staff per shift, to meet the residents need and assisting them with their needs in a timely manner. Three out of eight staff interviewed stated that there is not enough staff to assist the residents in a timely manner. Furthermore, based on staff interviews the facility will request staff from Epic Staffing if any staff calls out or will contact staff who are scheduled to be off if they can come in to cover. Work schedules from March, April and May 2022 shows that the facility schedules 3 - 4 staff to work during the AM and PM shift.

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.

Exit interview held and a copy of the report was provide

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 05/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2022

LIC9099 (FAS) - (06/04)

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