197608505-9-20-2022-28-AS-RORN-CKDQQ9-20221020122155

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 09/20/2022
Date Signed: 09/20/2022 02:01:49 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
09/14/2022 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220914082919

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:	09/20/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Brenda Chacon and Narine Mertkhanyan		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Residents are falling due to the facility being short staffed.
Staff are locking resident in her room.
Staff are not providing resident with her personal incidental money (P&I).
Staff are not providing activities for residents.
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INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted an initial complaint visit to investigate the above allegations. LPA met with Brenda Chacon (Office Manager) and Narine Mertkhanyan and discussed the purpose of today's visit.

During this investigation the following occurred: LPA obtained a copy of the staff and resident rosters, staff schedule for September 2022, list of residents who receive personal and incidental money and resident social activity schedule for September 2022 (Newsletter). LPA interviewed Staff #1 through Staff #5 (S-1 through S-5) and interviewed Resident #1 through Resident #6 (R-1 through R-6). LPA also reviewed resident files for R-1 through R-6 and obtained relevant documentation.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

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-20220914082919

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: 09/20/2022

NARRATIVE

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Allegation: Residents are falling due to the facility being short staffed. Interviewed staff indicated that there are (3) caregivers, (1) med tech and (1) licensed vocational nurse on staff on weekends. Staff interviews revealed that this facility utilizes (2) different staffing agencies and the staffing ratio remains the same in combination with the staffing agencies staff during the weekend. (2) out of the (5) interviewed staff indicated this facility has been recruiting for new staff, however, people who apply do not want to work on weekends. Staff will continue to recruit for new staff and utilize staffing agencies to provide staffing coverage. Interviewed staff indicated that recently there has not been resident falls on the weekends. LPA obtained a copy of the staff schedule (including staffing agency sign-in sheets). Interviewed residents indicated they have not witnessed residents falling on the weekends. Interviewed residents indicated they see staff conducting rounds daily (including the weekend). Staff and resident interviews do not corroborate this allegation.

Allegation: Staff are locking resident in her room. Interviewed staff indicated residents are not locked in their room. Staff interviews revealed that residents are placed in quarantine when ordered by a physician due to a medical condition such as scabies or COVID-19+ cases. Staff interviewed revealed that R-3 and R-6 were recently placed under quarantine for (1) week and were given a (1) time treatment. Both R-3 and R-6 have their own private rooms. Resident interviews revealed that staff do not lock them inside their room or in any room at this facility. Staff and resident interviews do not corroborate this allegation.

Allegation: Staff are not providing resident with her personal incidental money (P&I) Interviewed staff indicated S-1 handles the personal incidental money for residents. Per S-1, there are (5) residents that receive P&I in the beginning to each month. Per S-1, some of the P&I (at times) arrives a couple of days late and residents become upset when the money is not available. Per S-1, the P&I received is logged in and disbursed to the resident upon the residents’ request. (1) of (6) interviewed residents indicated they receive their P&I late. Staff and resident interviews do not corroborate this allegation.

Refer to LIC 9099C for the continuation of this report.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220914082919

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: 09/20/2022

NARRATIVE

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Allegation: Staff are not providing activities for residents. Interviewed staff indicated this facility has an Activity Director (S-2) that provides social activities for residents. Per staff interviews, social activities are provided daily (inside facility and outings) which consist of arts and crafts, exercise, dances, games, bingo, live entertainment every Friday, music therapy, gardening therapy, pet therapy and so forth. Per staff interviews, outings consist of going out for lunch at restaurants, shopping centers and some short day trips. Per staff interviews, residents are encouraged to participate (participation is voluntary). LPA obtained a copy of the monthly Newsletter which includes the monthly social activity calendar. LPA also observed the monthly social activity calendar posted. Interviewed residents indicated this facility provides social activities including outings. Staff and resident interviews do not corroborate this allegation.

Based on LPA's observations, and interviews, conducted the preponderance of evidence standard has been

met, therefore the above allegation(s) are found UNSUBSTANTIATED.

Exit interview conducted, appeal rights and a copy of this report was provided to Narine Mertkhanyan

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2022

LIC9099 (FAS) - (06/04)

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