197608505-10-31-2024-31-AS-NMAN-DCP2CH-20250106161646

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 10/31/2024
Date Signed: 10/31/2024 02:20:21 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 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: 62	DATE:	10/31/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Susan Park		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not address resident's ringworm infection.
Staff did not assist resident with oxygen.
Staff providing resident's oxygen to another resident in care.
Staff chemically restrained resident.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Abeye Duguma and Angelica Segovia conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. LPA met with administrator, Susan Park, and explained the reason for the visit.

--- Staff did not address resident's ringworm infection.

It was alleged that Resident #1 (R1) has ringworms that were not addressed. To investigate the allegation, on 07/24/2024 LPA requested pertinent documents at 11:00 AM and interviewed three (03) staff from around 11:45 AM to 1:00 PM. A review of the facility’s Medication Administration Records revealed that R1 was seen by a physician and given medications as prescribed for the ringworm infection. During interviews with staff, Staff #2 (S2) and Staff #3 (S3) stated that resident was given medications to treat ringworms. All other staff were unaware of the issue.
(CONT. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

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-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: 10/31/2024

NARRATIVE

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

--- Staff did not assist resident with oxygen.

It was alleged that staff does not check resident's oxygen. To investigate the allegation, on 07/24/2024 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 check on residents’ oxygen a minimum three (03) times a day. During interviews with residents, all residents stated they are unaware of how often staff check on residents’ oxygen tanks.

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

---Staff providing resident's oxygen to another resident in care.

It was alleged that resident’s oxygen has been used in other residents’ rooms. To investigate the allegation, on 07/24/2024 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 that they do not share R1’s oxygen with other residents. During interviews with residents, all residents stated they are not aware of oxygen tanks being shared.

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

(CONT on LIC9099-C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

LIC9099 (FAS) - (06/04)

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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: 10/31/2024

NARRATIVE

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---Staff chemically restrained resident.

It was alleged that staff admitted to "over medicating" resident. To investigate the allegation, on 07/24/2024 LPA requested pertinent documents at 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. A review of the facility’s Medication Administration Records revealed that residents are being given medications as prescribed. During interviews with staff, all staff stated they do not over medicate residents and give residents their medications as prescribed. During interviews with residents, all residents stated they get their medications as prescribed and do not feel over medicated.

Based on record review and 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: 10/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2024

LIC9099 (FAS) - (06/04)

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