197608505-9-21-2022-28-AS-MVAO-CJYQ56-20221007115123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 09/21/2022
Date Signed: 09/21/2022 03:19:02 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
09/12/2022 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20220912143538

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: 61	DATE:	09/21/2022
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Administrator, Narine Mertkhanyan		TIME COMPLETED:	03:33 PM

ALLEGATION(S):

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Facility does not have enough hygiene supplies
Facility is not adequately staffed
Staff do not shower resident
Facility did not provide transportation to doctors appointment.

INVESTIGATION FINDINGS:

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On 9/21/22 at 10:25 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced
Complaint investigation to the facility. Upon arrival LPA met with Narine Merthanyan (Administrator) and explained the purpose of the visit.

During today’s visit LPA toured the facility with the administrator and general manager, obtained resident roster, staff roster/ schedule, Bathing schedule, chauffer service schedule, R1 physician visit summary report dated 9/15/22 and purchase order for hygiene supplies dated 8/29/22. LPA interviewed residents R1 through R7. LPA Interviewed administrator, general manager, Staff S1, and S2.

Report continued on 9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

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-20220912143538

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: 09/21/2022

NARRATIVE

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The investigation reveals the following: Regarding "Facility does not have enough hygiene supplies", it is alleged that the facility does not have shampoo for residents. During the visit LPA observed enough hygiene supplies and shampoo located in the facility supply closet, in residents’ private bathrooms and communal showers. The administrator and general manager stated that the facility care staff check supplies every day and report to Staff 1(S1) whenever the resident’s supplies are low. 2/2 staff confirmed that they check the hygiene supplies of all residents daily and report when ever they notice the supplies are low. 6/7 residents stated they have enough hygiene supplies including shampoo and they don’t have any problems with the products. 1/7 residents stated they have shampoo, but the facility added water and foam do not form when using the product.

The investigation reveals the following: Regarding "Facility is not adequately staffed", it is alleged that it is not enough staff and the facility take too long to help residents. During the visit LPA tested the called light for rooms 9, 29, 31, 58 and 61. All care staff respond within the time frame of 2 minutes or less. LPA heard a reminder over the intercom during the test. LPA reviewed staff schedule and observed 4 care staff scheduled Monday- Saturday and 3 care staff on Sundays. The Administrator stated that the facility will always respond to the call light and send a reminder over the intercom. 2/2 staff stated they always respond and if they are busy the LVN also assist in responding to the call lights. 6/7 residents stated staff has always responded to their call and assisted them when needed. 1/7 residents stated there is not enough staff and it takes them 20-30 minutes to respond to a call.

The investigation reveals the following: Regarding "Staff do not shower residents", it is alleged that the facility will not shower R1 because they are too busy. During the visit LPA reviewed shower schedule and observed R1 is scheduled to have a shower every day. The administrator and general manager confirmed that residents are showered 2 times a week. They also stated that some residents request to be showered daily and they try to accommodate those residents. 2/2 staff stated they always shower residents and if they had an accident, they would give the residents an extra shower to make sure they are clean. 4/7 residents state they get showered twice a week and staff always give them a shower on their shower day. 2/7 residents stated they shower themselves and do not need assistance. 1/7 residents like to shower every day, but stated that if there are not enough staff, the facility cannot provide a shower. S1 stated last shower was yesterday 9/20/22.

The investigation reveals the following: Regarding "Facility did not provide transportation to doctors appointment", it is alleged that the facility did not take R1 to a scheduled doctor’s appointment. During the visit LPA reviewed the facility chauffeur book and observed R1 was picked up for a doctor’s appointment on 9/15/22. LPA also reviewed R1 Physician’s visit documentation dated 9/15/22. The administrator and general manager stated that the company has a bus that pick-up residents for schedule appointments. General manager stated that sometimes residents want a certain day, but the doctor’s office does not have it available. General Manager confirmed S1 went to the doctor on 9/15/22 and did not have an appointment on 9/12/22. 2/2 staff confirmed residents never missed doctors’ appointments. 6/7 residents stated that the facility has always assisted with transportation to the doctor. 1/7 residents stated that the facility did not provide transportation for an appointment on 9/12/22. S1 states that the next scheduled appointment is Wednesday.

Based on LPA's interviews observation and file review, investigation revealed: 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.

Exit interview conducted with Narine Merthanyan and a copy of this record provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 213-1556
LICENSING EVALUATOR NAME: Jewel Baptiste	TELEPHONE: (323) 400-9594
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2022

LIC9099 (FAS) - (06/04)

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