197608505-10-24-2022-28-AS-MVAO-CKXW4P-20221107155751

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 10/24/2022
Date Signed: 10/24/2022 01:40:17 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
10/26/2020 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201026110759

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: 60	DATE:	10/24/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Narine Mertkhanyan		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Administrator made inappropriate comments to the resident
Resident is being bullied
Resident is not getting his medical needs met
Resident is not allowed to leave the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s) LPA Angelica Rea and Kimberly Ramirez conducted another visit to deliver the final results of the investigation. LPAs met with Administrator, Narine Mertkhanyan who assisted with today's visit.

The investigation consisted of interviews with Administrator, Staff #1- Staff #4, and resident #1-resident #5, and review of resident #1's file. Regarding the allegation that Administrator made inappropriate comments to the resident #1. Administrator and staff interviewed denied that Administrator made inappropriate comments to resident(s). Residents interviewed were unable to corroborate the allegation. 4 out of 5 residents interviewed stated that the Administrator and staff do not make inappropriate comments to residents. Regarding the allegation that resident #1 is being bullied, Administrator and staff interviewed denied the allegation. They stated that none of the residents are being bullied to their knowledge. Residents interviewed were unable to corroborate the allegation. 4 out of 5 residents interviewed stated that residents are not being bullied. Regarding the allegation that Resident #1 is not getting his medical needs met, Administrator and Staff interviewed denied the allegation, and stated that the facility is meeting all of the residents medical needs.

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: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

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-20201026110759

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: 10/24/2022

NARRATIVE

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Residents interviewed were unable to corroborate the allegation. 4 out of 5 residents interviewed stated that the facility is meeting their medical needs. Regarding the allegation that the resident #1 is not allowed to leave the facility, Administrator and staff interviewed denied the allegation. They stated that resident #1 had a one on one companion, therefore he was unable to go out into the facility by himself. Administrator and staff stated that residents who are able to leave the facility are not prevented from doing so. 4 out of 5 residents interviewed stated that they are allowed to leave the facility if they choose.

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, Narine Mertkhanyan.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022

LIC9099 (FAS) - (06/04)

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