197608505-7-7-2023-31-AS-EMIR-DATPY6-20241108104323

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 07/07/2023
Date Signed: 07/07/2023 04:26:54 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/27/2023 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20230627165051

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:	07/07/2023
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Brenda Chacon		TIME COMPLETED:	04:35 PM

ALLEGATION(S):

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Uncleared staff providing care & supervision to residents
Staff mismanaged resident medications
Staff do not safeguard resident medication

INVESTIGATION FINDINGS:

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On 07/07/23 at 09:50 a.m., Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced complaint visit to investigate the allegations listed above. Upon arrival, LPA met with the Assistant Administrator Brenda Chacon and explained the purpose of the visit. An entrance interview was conducted.

At 9:58 a.m. LPA and Brenda started a physical plant tour of the facility. LPA did not observe any health and safety issues. From 10:00 a.m. to 11:00 a.m. LPA toured the medication room and conducted a medication review with the assistance of staff #1 (S1). LPA conducted a review of Centrally Stored Medication logs, Medication Administration Records, and observe S1 conduct pill counts. From 11:05 a.m. to 12:30 p.m. LPA conducted interviews with residents, staff, Assistant Administrator and current Administrator Narine Mertkhanyan. At 1:00 p.m. LPA reviewed and obtained records relevant to this investigation.

(Report continued on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

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 31-AS-20230627165051

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT GLENDALE - BOYNTON ST	FACILITY NUMBER: 197608505
	VISIT DATE: 07/07/2023

NARRATIVE

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Allegation#1: Uncleared staff providing care & supervision to residents.
It is alleged staff are not background cleared and have fake identification. To investigate the allegation, LPA
conducted interviews with the Assistant Administrator, and five (5) out of fifteen (15) staff currently working at the facility. LPA observed Staff #2's (S2), Staff #3's (S3), Staff #4's (S4), Staff #5's (S5) and the Assistant Administrator's CA Drivers License or State Identification. LPA observed documentation to be current and identified the staff member. At 12:45 p.m. LPA reviewed the Personnel Report (LIC500), and compared it to the Facility Personnel Report Summary and the Facility Roster Information mailed to the Licensee from Community Care Licensing. Records revealed all 27 staff listed on LIC 500 are cleared and associated to the facility. Furthermore Assistant Administrator states the human resources representative which is off-site, staff #6 (S6), is responsible for on boarding any future staff and not until they are background cleared, associated, conduct their health screening and have initial training do staff begin at the facility for their next phase of training. Based on LPA's observation, interviews and file review, the above allegation has been determined to be UNSUBSTANTIATED.

Allegation #2: Staff mismanaged resident medications.
It is alleged Medication Administration Records (MARs) are falsified. To investigate the allegation, LPA
conducted interviews with the Assistant Administrator, the current Administrator Narine Mertkhanyan and S1. LPA and S1 compared a random selection of six residents' MARs to the medication they have stored in the medication room. LPA compared MARs to the Centrally Stored Medication logs for those same six residents. LPA did not observe discrepancies. Interview with S1 revealed the pharmacy fills out the Centrally Stored Medication and MARs for most residents in the facility. Furthermore, According to the Assistant Administrator, the staff in charge of administering medication will roll the medication cart out to meet the residents and take the MAR folder with them. As medications are administered to the resident the staff will mark it off on the MAR. Based on LPA's observation, interviews and file review, the above allegation has been determined to be UNSUBSTANTIATED.

Allegation #3: Staff do not safeguard resident medication
It is alleged medication is being removed and not accounted for in the medication room. To investigate the allegation, LPA conducted interviews with the Assistant Administrator, the current Administrator Narine Mertkhanyan and S1.

(Report continued on LIC9099-C)

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230627165051

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT GLENDALE - BOYNTON ST	FACILITY NUMBER: 197608505
	VISIT DATE: 07/07/2023

NARRATIVE

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LPA observed S1 unlock the door to the medication room and unlock the medication cart when medication was being pulled out for counting. LPA and S1 compared a random selection of six residents MAR to the medication they have stored in the medication room. LPA compared MARs to the Centrally Stored Medication logs for those same six residents. One medication for resident #2 (R2) was not accounted for. According to the Administrator they had run out of it the night before and put in an order this morning. Administrator states she reminded staff not to throw away empty medication bottles without properly documenting. Furthermore the Administrator stated only the staff designated to give out medication and the facility nurse are allowed in the medication room. Based on LPA's observation, interviews and file review, the above allegation has been determined to be UNSUBSTANTIATED.

No deficiencies cited. Exit Interview Conducted. A Copy of the Report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 07/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/07/2023

LIC9099 (FAS) - (06/04)

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