197608505-4-19-2024-31-AS-NMAN-D59R97-20240514124904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 04/19/2024
Date Signed: 04/19/2024 03:47:09 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
10/02/2023 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20231002125242

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: 74	DATE:	04/19/2024
		UNANNOUNCED	TIME BEGAN:	09:38 AM
MET WITH:	Brenda Chacon		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

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Staff are abusing the residents while in care.
Staff are inappropriately tying the facility doors at night.

INVESTIGATION FINDINGS:

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

--- Staff are abusing the residents while in care.

It was alleged that staff are abusing seniors. To investigate the allegation, on 04/19/2024 LPA conducted a physical plant tour at 9:30 AM, interviewed seven (07) residents from 10:30 AM to 12:30 PM and interviewed three (03) staff from 12:30 PM to 02:00 PM. During physical plant tour, LPA observed that all residents were clean, well groom and did not have any signs of physical abuse. During interviews with residents, all residents stated that they have never been physically or verbally abused by any staff.

(CONT. on LIC9099-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: 04/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

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-20231002125242

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: 04/19/2024

NARRATIVE

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During interviews with staff, all staff stated they have never physically or verbally abused a resident or witnessed staff abusing any resident.

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

--- Staff are inappropriately tying the facility doors at night.

It was alleged that staff are tying the doors shut at night. To investigate the allegation, on 04/19/2024 LPA conducted a physical plant tour at 9:30 AM, interviewed seven (07) residents from 10:30 AM to 12:30 PM and interviewed three (03) staff from 12:30 PM to 02:00 PM. During physical plant tour, LPA did not observe at doors tied up or mechanisms that can be used to tie up doors. During interviews with residents, all residents stated that their doors have never been tied up by anyone. During interviews with staff, all staff stated they have never tied up anyone’s door.

Based on observations and 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 was conducted and a copy of 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: 04/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2024

LIC9099 (FAS) - (06/04)

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