197608505-10-17-2022-28-AS-MVAO-CLMR6A-20221129114426

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 10/17/2022
Date Signed: 10/17/2022 01:32:57 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
01/06/2022 and conducted by Evaluator Ashley Calderon

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220106080051

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: 58	DATE:	10/17/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator- Narine Mertkhanyan		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Facility discriminated against resident.
Violation of personal rights.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Calderon made an unannounced visit to the facility and met with Narine Mertkhanyan. LPA explained the reason of the visit to Mertkhanyan, who assisted with the visit.

LPA Calderon is following up on a needs further conducted initially by LPA Tao on 1/11/22.LPA Calderon reviewed all documentation's gathered by LPA Tao prior to todays visit.

On todays visit 10/17/22 there was a census of 58 resdients and 40 staff.LPA Calderon's investigation consisted of residents R #2-6 (R2, R3,R4 ,R5,R6) and staff interviews S1-5 (S1,S2,S3, S4,S5). LPA Calderon collected R2-R10 LIC 613c -Personal Right form, staff training on Personal Rights and Discrimination documentation was provided.

(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

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-20220106080051

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: 10/17/2022

NARRATIVE

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The investigation revealed the following:
Regarding allegation #1 – Facility discriminated against resident.
LPA Calderon interviewed 5 residents. 5 out of 5 residents stated facility does not discriminate against residents stated they are not discriminated against by staff. When asked have you experienced discrimination R2-R6 stated no issues on discrimination, no violations against discrimination experienced. When asked if resident have witnessed discrimination against any residents by staff. S5 stated "No everyone gets treated the same." S3 stated " I have not witnessed discrimination, they comply with the rules." LPA Calderon interviewed 5 staff whom 5 out of 5 stated discrimination training is provided and not not discriminate residents or have witnessed discrimination.

Regarding allegation #2: Violation of personal rights. LPA Calderon interviewed 5 out of 5 residents who stated their personal rights are being respected and the facility does not violate their personal rights.
LPA Calderon interviewed staff and 5 out of 5 stated there is training provided on personal rights. When asked if there a time were you witnessed staff violating personal rights of residents 5 out of 5 stated they have not witnessed staff violating residents personal rights and they respect residents personal rights.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report and appeal rights were provided to Narine Mertkhanyan.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

LIC9099 (FAS) - (06/04)

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