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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 07/24/2024
Date Signed: 07/24/2024 03:36:14 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
07/22/2024 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20240722200124
FACILITY NAME:GLEN PARK AT GLENDALE - BOYNTON STFACILITY NUMBER:
197608505
ADMINISTRATOR:PINK, JR, TILLMANFACILITY TYPE:
740
ADDRESS:1250 BOYNTON STTELEPHONE:
(818) 246-9000
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:98CENSUS: 68DATE:
07/24/2024
UNANNOUNCEDTIME BEGAN:
11:01 AM
MET WITH:Vanessa OrtegaTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not provide toilet paper for resident.
Staff did not keep the facility clean and sanitary.
Staff handled resident in a rough manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to the facility to investigate the above allegation. LPA met with Vanessa Ortega and explained the reason for the visit.

--- Staff did not provide toilet paper for resident.

It was alleged that facility does not provide toilet paper to Resident #1 (R1). To investigate the allegation, LPA conducted a physical plant tour at around 11:00 AM, interviewed three (03) staff from around 11:45 AM to 1:00 PM and interviewed seven (07) residents from around 1:00 PM to 3:00 PM. During the physical plant tour, LPA observed toilet paper in the R1’s room. During interviews with staff, all staff stated that all residents are provided toilet paper and are never without access.

(CONT. on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
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-20240722200124
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: 07/24/2024
NARRATIVE
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During interviews with residents, all residents stated they have never been denied access to toilet paper.

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

--- Staff did not keep the facility clean and sanitary.

It was alleged that R1’s room had feces on bathroom walls, feces on R1’s towels and vomit on R1’s bed. To investigate the allegation, LPA conducted a physical plant tour at around 11:00 AM, interviewed three (03) staff from around 11:45 AM to 1:00 PM and interviewed seven (07) residents from around 1:00 PM to 3:00 PM. During the physical plant tour, LPA did not observe any feces on the bathroom walls, feces on towels or vomit on the beds of residents. During interviews with staff, all staff stated they are not aware of residents having feces on the bathroom walls, feces on residents’ towels or vomit on the beds. During interviews with residents, all residents stated they have never witnessed feces on walls, vomit on beds or feces on towels.

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

--- Staff handled resident in a rough manner.

It was alleged that staff were observed to be grabbing residents by the arm and yanking them away. To investigate the allegation, LPA interviewed three (03) staff from around 11:45 AM to 1:00 PM and interviewed seven (07) residents from around 1:00 PM to 3:00 PM. During interviews with staff, all staff stated they do not treat residents in a rough manner, have never yanked any resident and are gentle with everyone. During interviews with residents, all residents stated that staff are gentle when handling them.

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 were noted during the visit.
Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3