197608505-7-8-2021-28-AS-MVAO-C55UG3-20210721153339

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 07/08/2021
Date Signed: 07/08/2021 12:11:08 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/09/2020 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20201209101227

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:	07/08/2021
		UNANNOUNCED	TIME BEGAN:	08:37 AM
MET WITH:	Brenda Chacon -Assistant Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility has inadequate food service.
Staff withholding resident check.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced complaint investigation regarding the above allegations. LPA Flores met with assistant administrator and explained the reason for the visit.

The investigation consisted of the following: LPA Flores conducted a tour of the kitchen and observed sufficient food supplies for 2 days of perisable and 7 days of non perishable items. LPA requested copies of staff/resident roster, record of resident's safeguard sheet, face sheet, pyshician's report, and appraisal needs and care plan for residents #1(R1), #2(R2), #3(R3), #4(R4), #5(R5), #6(R6), #7(R7) and a copy of facility's menu for the last three months. LPA Flores interviewed R1,R2,R3,R4,R5, R6, was not able to interview R7 as had moved out of facility, and staff #1(S1), #2(S2), #3(S3), #4(S4), #5(S5), #6(S6), #7(S7).

The investigation revealed the following: Regarding allegation; Facility has inadequate food service. It is alleged that the food is not good at all. During the tour of the kitchen LPA observed food supplies that consisted of the following: pantry was observed to have variety of fresh fruits, potatoes, variety of can foods including fruits, and beans, cereals and pastas. (CONTINUED ON LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

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-20201209101227

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT GLENDALE - BOYNTON ST	FACILITY NUMBER: 197608505
	VISIT DATE: 07/08/2021

NARRATIVE

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Facility has a freezer that has meats, and vegetables and 2 refrigerators that have vegetables, milk, eggs, and cheese. During interviews with residents, 5 out 6 residents stated to like the food, 2 out of the 5 stated to get something they request or something else when residents don't like what facility is serving. 1 out of 6 residents stated not to like the food due to food preferences and diet. During interviews with staff 7 out of 7 staff stated facility provides sandwiches, salad, or fruits when residents request for something else during a meal, facility has 5 different menus and menu gets rotated once a week, facility follows diets for residents with special diets. LPA reviewed facility's menu which contains a variety of foods for each meal covering all food groups. Resident documents reviewed revealed 5 out 6 residents have a special diet and facility maintains a special dietary needs sheet with special diet instructions of each resident.
Based on LPA's observation and interviews, conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.

Regarding allegation: Staff withholding resident check. It is alleged that staff will not provide resident allowance to get things such as clothing and undergarments. During interviews with residents, 2 out of 6 residents stated to receive allowance money, to have all clothing needs met, and that facility staff takes resident to purchase clothing when needed. 3 out of 6 residents stated not to receive allowance money, 1 stated to be taken by staff to the store to get clothes, 1 stated to get own clothes, and 1 stated facility does not assist with getting clothes. During interview with 1 out of 6 residents LPA was unable to understand resident's answer due to cognitive and speech skills. During interviews with staff, 4 out of 7 staff stated residents receive allowance money which is provided on Tuesdays and Thursday to the residents and signed off in record of resident's safeguard and voucher, staff will purchase clothes online or take residents to the store to purchase clothing when residents request or staff notices need. 3 out 7 staff were not aware of financial matters related to the residents. Documents reviewed revealed that 1 out of 6 residents is able to manage cash resources and 5 out of 6 residents is not able to handle cash resources. Record of resident's safeguard revealed facility maintains track of 4 out of 6 residents of money provide by tracking amount received, amount provided,date, balance, and signature, 1 out of 6 residents handles own finances, and 1 out of 6 residents has a family member handling finances.
Based on LPA's interviews and document review, conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.

Exit interview was conducted with Brenda Chacon assistant administrator and a copy of the report was provided.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2021

LIC9099 (FAS) - (06/04)

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