197608505-4-12-2025-31-AS-NMAN-DHBMBX-20250604092840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 04/12/2025
Date Signed: 04/12/2025 01:29:40 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
09/12/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20240912122906

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: 63	DATE:	04/12/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Susan Park		TIME COMPLETED:	01:40 PM

ALLEGATION(S):

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Staff did not prevent resident from being sexually abused

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent visit for the above allegation. LPA met with Executive Director, Susan Park, and explained the reason for the visit.

--- Staff did not prevent resident from being sexually abused.

It was alleged that Resident #1’s (R1) son was kissing R1 using his tongue, "French kissing" and cuddling with the resident naked. To investigate the allegation, on 09/12/2024, LPA requested pertinent documents at 2:30p.m. and interviewed one (01) staff from 2:30p.m. to 3:00p.m. On 09/13/2024, IB Investigator Lorraine Patterson (IB) received a police report from the Glendale Police Department. On 10/15/2024, IB requested and reviewed additional documents. On 10/21/2024 IB interviewed R1 and requested additional documents.

(CONT on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2025

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-20240912122906

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: 04/12/2025

NARRATIVE

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On 10/31/2024, at approximately 9:30a.m., IB visited the facility and obtained a printed copy of Incident Reports.

A review of the Unusual Incident Report dated 03/04/2024 states, on 01/28/2024, R1’s son brought CBD oil, unknown supplements, and three condoms to the facility, all of which were confiscated and brought to the office. The report also states, on 03/04/2024 R1’s son was not wearing anything below the waist but using separate blankets. Staff reported it to the Long-Term Care Ombudsman (LTCO). Staff #1 (S1) stated they would partner with the LTCO and the Regional Office (RO) to develop a plan of action that preserves R1’s relationship with their son. The report also states that on 09/10/2024, Staff #2 (S2) reported the incident to Adult Protective Services (APS) by phone and fax that R1’s son was receiving R1’s Social Security income but was not paying R1’s rent putting R1 in danger of eviction. Additionally, S2 added R1’s son stays at the facility and sleeps in the same bed as R1, that the bed is a twin size and is too small to accommodate two (02) people.

The Glendale Police Department's report states that Officer Ryan Varela #28091 responded to the facility at 8:00p.m. on 9/11/2024 because of a report alleging R1’s son sleeps “half nude” with R1, is not paying R1’s rent, and interferes with R1’s medication administration. Staff #3 (S3) asked to speak with Off. Varela in private and stated that R1’s son stays beyond visiting hours and is sometimes there for days at a time. The facility administrator has been reluctant to trespass R1’s son because they hold R1’s power of attorney (POA). S3 told Off. Varela that Staff #4 (S4) submitted an internal report about a year ago after observing inappropriate kissing. The report adds upon entering R1’s room, off. Varela observed R1’s son sleeping at the foot of R1’s bed, with R1 sleeping in the bed. R1’s son initially did not want to provide a statement, so off. Varela attempted to interview R1, but it was apparent that R1 did not have the capacity to provide a coherent statement. R1 stated they were fine and happy but then said they were scared, needed help, and did not know what was going on. When R1’s son later agreed to answer questions, he said he never touched R1 in a sexual way, kissed R1 inappropriately, or has been naked in front of R1. Concerning the door being blocked with a chair, R1’s son stated he was moving furniture and unintentionally left a night stand in front of the door.

Based on the questionable behavior reported by facility staff and the facility’s unwillingness to trespass R1's son, off. Varela decided to obtain an emergency protective order (EPO) on R1’s behalf.
(CONT on LIC9099-C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 04/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240912122906

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: 04/12/2025

NARRATIVE

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The EPO was granted by Judge Knight and took effect immediately, through 9/18/2024. Off. Varela personally served the EPO and escorted R1’s son off the property.

R1’s Physician’s Report confirms that R1 has Dementia, Bi-polar disorder, Anxiety disorder, confused, disoriented and wandering behavior.

During interviews with staff, all staff stated R1’s son kisses and touches R1 inappropriately using their tongue when kissing and sleeps in bed nude with R1. Staff #5 added they witnessed open condoms in the

During interviews with residents, R1 stated they do not feel uncomfortable with their son’s visits and feels agitated, but when asked how they engage during their visits, R1 raised their voice, and told IB they no longer wanted to answer questions.

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

No health and safety hazards noted at the time of this 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: 04/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2025

LIC9099 (FAS) - (06/04)

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