197608505-6-3-2021-28-AS-MVAO-C4WTAW-20210714143415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 06/03/2021
Date Signed: 06/03/2021 04:27:38 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/05/2020 and conducted by Evaluator Alexander Pitz

COMPLAINT CONTROL NUMBER: 28-AS-20200305103350

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:	06/03/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Brenda Chacon		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff is stealing residents personal funds while in care
Staff is mishandling residents while in care
Staff is verbally abusive towards the residents while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) conducted an unannounced visit on this day in response to the above allegations.

As part of this investigation, LPA interviewed 7 residents and 1 staff member telephonically on 8/13/20 in addition to reviewing a selection of Personal and Incidental (P&I) funds provided by the administrator. On 6/3/21 LPA interviewed 6 staff members and 6 residents, in addition to reviewing a random selection of client P&I ledgers.

Allegation #1, that "Staff is stealing residents personal funds while in care," has been unsubstantiated based on the interviews conducted and records reviewed. LPA did not receive any corroborating evidence or testimony to support this allegation, and observed the facility to be logging client expenditures appropriately.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 5964342
LICENSING EVALUATOR NAME: Alexander Pitz	TELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

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-20200305103350

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: GLEN PARK AT GLENDALE - BOYNTON ST	FACILITY NUMBER: 197608505
	VISIT DATE: 06/03/2021

NARRATIVE

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Allegation #2, that "Staff is mishandling residents while in care" has been unsubstantiated based on the staff and client interviews conducted. LPA did not receive any corroborating evidence or testimony to support this allegation.

Allegation #2, that "Staff is verbally abusive towards the residents while in care" has been unsubstantiated based on the staff and client interviews conducted. LPA did not receive any corroborating evidence or testimony to support this allegation.

Report reviewed and delivered. A signed hard copy will be returned to LPA via email and kept in the facility's file.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 5964342
LICENSING EVALUATOR NAME: Alexander Pitz	TELEPHONE: (805) 450-1627
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2021

LIC9099 (FAS) - (06/04)

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