197608505-4-5-2024-31-AS-NMAN-DBW27M-20241212160859

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 04/05/2024
Date Signed: 04/05/2024 05:10:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
03/26/2024 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240326093807

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: 73	DATE:	04/05/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	General Manager(GM), Brenda Chacon		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff stole resident's personal property
Staff did not ensure resident's dietary needs are met
Staff did not ensure resident's toileting needs are met
Staff intimidate residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Antonia Alvizar-Ettima conducted an unannounced initial complaint visit to this facility at approximately 9:10a.m. LPA met with Receptionist, Iris Ortega and Activity Director(AD), Daysy Regalado at that time LPA request staff and resident rosters. At 9:15a.m. AD and LPA conducted a physical plant tour of the facility. At 9:30a.m. the GM arrived at the facility and explained the reason for this visit.

At 9:40a.m. GM provided staff and resident roster to LPA. GM also indicated on roster the residents that are verbal and receive incontinence care. Between 9:45a.m. to 12:00p.m. LPA interviewed seven (07) out of seventy-three (73) residents including resident (R1), GM and three (3) staff that assist R1. LPA asked interview questions relevant to the nature of the complaint. At approximately 10:15a.m LPA requested R1’s Physician's Report, Resident Appraisal, Resident's Personal Property Inventory,Client Notes, Special Dietary List, Nutritionist Menu and Staff Inservice Training. At 1:45p.m. LPA received and reviewed documents related to the allegations above.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

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-20240326093807

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT GLENDALE - BOYNTON ST	FACILITY NUMBER: 197608505
	VISIT DATE: 04/05/2024

NARRATIVE

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1)Staff stole resident's personal property
It was alleged that staff stole R1’s money and cellphone. Interview with R1 reveal that they thought staff stole money and cellphone when away from the facility for a couple days. R1 indicated that when they returned the money and cellphone was at the facility and locked. Interviews with residents revealed that they have never experienced any of their personal property being stolen. Staff interview revealed that R1 has never reporter money and cellphone being stolen. General Manager(GM), indicated that R1 called from the hospital and informed her that cellphone was left at the facility. GM immediately searched for the cellphone, found it and locked it in the office. When R1’s came back to the facility GM returned the cellphone. GM indicated that R1 never reported staff stealing money. A review of R1’s Personal Property Inventory dated 03/18/2024 does not indicated that R1 has a cellphone or money.

Based on interviews and documents review there is an insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

2) Staff did not ensure resident's dietary needs are met
It was alleged that staff has not fed R1 the appropriate diabetic food. Interview with R1 reveal that staff are providing appropriated diabetic food but they sometimes can not wait for meal time so they order fast food using Uber Eats service. Interviews with residents revealed that they receive appropriate diabetic food.
Staff interviews revealed that R1 has been provided appropriate diabetic food. GM indicated that R1 has not request food before or after meal time. Facility staff provides food before or after meal time upon resident's request. A review of facility Resident’s Special Dietary Needs indicated that R1 receives diabetic food. Physician's Report indicated that R1 has an eighteen hundred (1,800) calorie special diet. Facility menu is created and approved by Dietitians of OC monthly.

Based on interviews and documents review there is an insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

3) Staff did not ensure resident's toileting needs are met
It was alleged that at times R1 has woken up on they bodily fluid. Interview with R1 reveal that has not woken up on bodily fluid and does not need any toileting needs. R1 indicated that they can perfectly walk, does not need diapers and is independent. Interviews with residents revealed that staff ensure all their toileting needs are met.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240326093807

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT GLENDALE - BOYNTON ST	FACILITY NUMBER: 197608505
	VISIT DATE: 04/05/2024

NARRATIVE

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Residents did not have any concerns about toileting needs. Staff interviews concede with R1’s response. A review R1’s Physician Report indicated that R1 is able to care for own toileting needs.

Based on interviews and documents review there is an insufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

1) Staff intimidate residents in care
It was alleged that staff intimidate R1 by not allowing they to leave the facility.

Interview with R1 reveal that they do not get intimidated by staff and has not want to leave the facility. Interviews with residents did not indicate any concerns about staff intimidating them. Resident (R5) indicated I communicate with staff and they are nice with me. Staff interviews reveal that R1 has not reported feeling intimidated by staff because they wanted to leave the facility. During physical plant tour, LPA did not observe staff intimidating residents in care. A review of facility Inservice Training dated 03/14/2024 indicated that staff received training on "How to Communicate & Positive Approach to Dementia Care Customer Service". R1’s Physician Report indicated that R1 is not able to leave the facility unassisted.

Based on interviews, observation and documents review there is an insufficient information to support 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.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima	TELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2024

LIC9099 (FAS) - (06/04)

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