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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 08/05/2025
Date Signed: 08/05/2025 03:38:47 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
07/30/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250730155846
FACILITY NAME:GLEN PARK AT GLENDALE - BOYNTON STFACILITY NUMBER:
197608505
ADMINISTRATOR:SUSAN PARKFACILITY TYPE:
740
ADDRESS:1250 BOYNTON STTELEPHONE:
(818) 246-9000
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:98CENSUS: 66DATE:
08/05/2025
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Susan Park, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Licensee does not ensure enough staff to meet the needs of residents
INVESTIGATION FINDINGS:
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On 08/05/25, at 8:55am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator, Susan Park. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 08/05/25, at 9:35am, LPA Saucedo asked for the census, staff, and resident rosters. At 10:20am, LPA Saucedo conducted a physical tour, interviewed staff and residents.

LIC 9099C-continued
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 31-AS-20250730155846
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: 08/05/2025
NARRATIVE
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Regarding the allegation: Licensee does not ensure enough staff to meet the needs of residents. It is being alleged that the above facility has limited staff and therefore resident #1 (R1)’s needs are not being met. LPA interviewed five (5) staff that confirmed there are five (5) caregivers working the morning shift, afternoon shift and three (3) caregivers on the night shift. In addition, there are four (4) one-on-one staff providing 24 hour care to four (4) residents. LPA interviewed two (2) residents that confirmed their needs are being met by staff. LPA attempted to interview four (4) other residents but they did not understand and/or were able to answer LPA's questions. Let it be noted, these residents are diagnosed with dementia. LPA obtained the caregivers schedules that confirm there are five (5) caregivers in the morning and afternoon shift, three (3) caregivers at night and four (4) staff providing one-on-one care. During LPA's physical tour, LPA observed five (5) caregivers, the Activities Director, two (2) medical technicians, the administrator and assistant administrator and front desk staff. Therefore, based on the LPA's observations, staff and resident interviews, the above allegation(s) above is UNSUBSTANTIATED at this time.


An exit interview was conducted, no citation(s) were issued, and a copy of this report was given to the Administrator.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
07/30/2025 and conducted by Evaluator Gina Saucedo
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250730155846

FACILITY NAME:GLEN PARK AT GLENDALE - BOYNTON STFACILITY NUMBER:
197608505
ADMINISTRATOR:SUSAN PARKFACILITY TYPE:
740
ADDRESS:1250 BOYNTON STTELEPHONE:
(818) 246-9000
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:98CENSUS: 66DATE:
08/05/2025
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Susan Park, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not seek timely medical attention for resident in care
INVESTIGATION FINDINGS:
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On 08/05/25, at 8:55am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Administrator, Susan Park. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 08/05/25, at 9:35am, LPA Saucedo asked for the census, staff, and resident rosters. At 10:20am, LPA Saucedo conducted a physical tour, interviewed staff and residents.

LIC 9099C-continued
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20250730155846
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: 08/05/2025
NARRATIVE
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Regarding the allegation: Staff did not seek timely medical attention for resident in care. It is being alleged that because resident #1 (R1) did not receive medical attention on a timely basis, R1 got an infection and needed surgery. During LPA's record review regarding R1, LPA observed the R1 receives ALW-Assisted Living Waiver and is under Tier 4. The assisted living waiver states R1 needs extensive assistance with ADL's-Activities of Daily living. Some of the activities of daily living that R1 needs help with is incontinence care and bathing. ALW documentation shows that R1 needs total dependence of toilet use and bathing. In addition, its shows rashes and itchiness to be a problem. Furthermore, the Appraisal/Needs and Services Plan shows that R1 needs assistance with bladder incontinence; therefore, using pull-ups and/or diapers. R1's Physican's report shows that R1 has a history of skin conditions or breakdown. R1's resident appraisal and Functional Capability Assessment shows R1 needs help with toileting and bathing. LPA interviewed four (4) staff that confirmed R1 needs help with toileting and bathing. One (1) out of the four (4) staff confirmed that R1 had pimples and rashes in their private area and noticed it while showering R1. Another staff confirmed that R1 would always be scratching and noticed rashes in their hand area but also confirmed that they heard other staff saying R1 had rashes in their private area. R1 was taken to the Glendale Memorial Hospital on 07/22/25 by their daughter because of fever and chills and it was determined by medical records that R1 had scrotal cellulitis/scrotal abscess and needed a immediate surgery to avoid sepsis. LPA requested medical records from Glendale Memorial Hospital and they were received on 08/04/25 confirming that R1 needed immediate medical attention. Therefore, based on the LPA's observations of the medical records, ALW documents, physicians report, resident appraisal, functional capabilities and needs and services plan, and staff interviews the above allegation(s) above is SUBSTANTIATED at this time.


An exit interview was conducted, citation(s) were issued, appeal rights and a copy of this report was given to the Administrator.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20250730155846
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/06/2025
Section Cited
HSC
1569.269(a)(6)
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§1569.269 Enumerated rights; severability(a) Residents of residential care facilities for the elderly shall have all of the following rights:(6) To care, supervision, and services that meet their individual needs... This requirement is not met by:
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Licensee/Administrator will provide training to all staff on the care, supervision and services to all residents.

POC Due Date: 08/06/25
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Based on the LPA's record review and staff Interviews the licensee/administrator failed to ensure the care, supervision and services of resident #1 (R1) while in the facility. This posed an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5