197608505-9-4-2025-31-AS-NMAN-DMJSHY-20251017135420

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 09/04/2025
Date Signed: 09/04/2025 02:52:42 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
06/26/2025 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20250626110852

FACILITY NAME:	GLEN PARK AT GLENDALE - BOYNTON ST		FACILITY NUMBER:	197608505
ADMINISTRATOR:	SUSAN PARK		FACILITY TYPE:	740
ADDRESS:	1250 BOYNTON ST		TELEPHONE:	(818) 246-9000
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	98	CENSUS: 66	DATE:	09/04/2025
		UNANNOUNCED	TIME BEGAN:	10:44 AM
MET WITH:	Susan Park, Edwin Sanchez		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not provide resident medication as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegation. The 10 day visit was made bye LPA Mariana Agban on 06/26/25. Today, LPA met with the assistant administrator, Edwin Sanchez and advised him of the complaint. The administrator, Susan Park, was advised of the complaint and joined shortly after. Today's investigation consisted of a physical plant inspection (between 11:00am-12:00pm), Record review (between 12:00pm-1:00pm), and interviews with staff and residents (between 1:00pm-2:00pm).

In regards to the above allegation, it's reported that Resident 1's (R1) medication for Keppra was stopped being administered by facility staff without the doctor's orders. Prescription for Keppra, should have decreaed, but not stopped entirely. Facility staff did not follow R1's prescription orders as prescrbied. As a result of the stoppage, or discontinued use of Keppra, R1 experienced a seizure.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Angela J Whittaker
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

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-20250626110852

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: 09/04/2025

NARRATIVE

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Interviews with the facility administration and Staff 1 (S1) deny the allegation. According to administration and staff, R1's Keppra was ordered to be given on or off by R1's physician or the pharmacy. Nonetheless, Keppra was being administered as prescribed.

Review of facility records and documentation of R1's orders for Keppra reveal the follwing:

06/09/25- Order for Keppra was stopped
06/15/25- Order for Keppra is to start, one (1) tablet, two (2) times daily for thirty (30) days
06/28/25- Order for Keppra was changed to take one (1) tablet, once a day

Copy of R1's Medication Administration Record (MAR) for June and July 2025 obtained to insure R1's Keppra was given as ordered. No discrepancy observed through July 22, 2025, when R1 was sent to the hospital. R1 has been in the hospital since July 22, 2025. Discharge unknown at this time.

In addition, interview with ten (10) of then residents made. These interviews are inconsistent and do not corroborate with the allegation of staff not giving the resident's medications as prescribed.

Based on the information obtained, there wasn't enough evidence to prove the allegation of staff not providing resident medications as prescribed. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Angela J Whittaker
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 09/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/04/2025

LIC9099 (FAS) - (06/04)

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