197608505-9-20-2023-31-AS-NMAN-CYHVVP-20231214154641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 09/20/2023
Date Signed: 09/20/2023 03:54:37 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, 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
09/19/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20230919112018

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: 64	DATE:	09/20/2023
		UNANNOUNCED	TIME BEGAN:	09:11 AM
MET WITH:	Peter Bonilla, Executive Director		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not provide proper transportation assistance to resident in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced complaint visit to the facility to investigate the above allegation. LPA met with Executive Director, Peter Bonilla, and explained the reason for the visit.

--- Staff did not provide proper transportation assistance to resident in care.

It was alleged that on 09/19/2023, Resident #1 (R1) was refused transportation assistance for a doctor’s appointment. To investigate the allegation, on 09/20/2023 LPA interviewed 02 (two) staff at 11:15 AM, requested records 12:15pm and interviewed six (06) residents at 1:00 PM. During interviews with staff, both Staff #1 (S1) and Staff #2 (S2) stated residents are assisted with transportation to doctor’s appointments.

(CONT. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

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 31-AS-20230919112018

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT GLENDALE - BOYNTON ST	FACILITY NUMBER: 197608505
	VISIT DATE: 09/20/2023

NARRATIVE

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S2 added there was no need to schedule transportation services on 09/19/2023 as the doctor was scheduled to visit client at the facility. A review of facility’s Client Notes revealed on 09/19/2023 R1 was seen by doctor at the facility. During interviews with residents, R1 stated there was a misunderstanding, and the doctor visited facility to see R1. R1 added they were refused transportation on three (03) separate occasions. Two (02) out of six (06) residents stated they do not use the facility’s transportation services and the remaining three (03) out of six (06) stated the facility assists with transportation services for doctor’s appointments and have never been refused services.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023

LIC9099 (FAS) - (06/04)

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