197608505-3-18-2021-28-AS-MVAO-C5KP6S-20210804110249

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 03/16/2021
Date Signed: 03/18/2021 08:33:05 AM

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
02/19/2021 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210219091411

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: 61	DATE:	03/16/2021
		UNANNOUNCED	TIME BEGAN:	10:42 AM
MET WITH:	Nirjara Archarya-Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff not providing adequate food service for resident.
Staff not keeping residents room free from pests.
Staff opened residents mail.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong initiated a subsequent complaint investigation to deliver findings on the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Administrator Nirjara Archarya

The investigation consisted of the following: On 02/25/21, LPA initiated a 10-day complaint and a virtual physical plant inspection of resident rooms was conducted. LPA also interviewed administrator, office manager and residents #1- #7 (R1-R7). On 03/04/21, LPA also interviewed addition four (4) staff.

The investigation revealed of the following: Allegation#1 “Staff not provide adequate food services for resident.” LPA interviewed seven residents and they all denied the allegation. They all reported the food is good in the facility and all residents receive enough food each meal.
See LIC 9099C for continuation of report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021

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-20210219091411

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: 03/16/2021

NARRATIVE

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LPA asked staff and reported all staff are required wear hair net and gloves in the kitchen. In addition, staff also provide substitute food such as sandwiches, fruit salad or soup for resident if its needed.

Allegation#2 “Staff not keeping residents’ room free from pests. “LPA interviewed 7 residents and five reported the residents’ rooms and the facility are very clean. They also reported they had never seen any pests in the facility. LPA interviewed staff reported R1’s room is full of boxes while R1 first came and all the boxes were unpacked. Therefore, they do not know where the pest came from. Staff also reported they had never seen any bugs in the facility. Administrator also reported the facility maintenance staff already fumigated R1’s room.

Allegation#3 “Staff opened residents’ mail.” LPA interviewed 7 residents, and all denied staff opened residents’ mail. They stated that the staff usually would call the residents’ name to pick up the mail in the front office or staff would deliver the residents’ mail to the rooms. LPA interviewed staff and all denied the allegation and stated they would never open resident’s mail, they also received the personal right training.

Based on statements and interviews conducted with clients and there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there are not a preponderance of evidence to prove the alleged violations did or did not occur, therefore all the allegations are UNSUBSTANTIATED.

A telephonic exit interview was conducted with Administrator Nirjara Archaryaand a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 03/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/16/2021

LIC9099 (FAS) - (06/04)

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