197608505-10-1-2025-31-AS-NMAN-DQ45K8-20260106190107

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 10/01/2025
Date Signed: 10/01/2025 02:52:35 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
06/20/2025 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20250620115653

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:	10/01/2025
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Edwin Sanchez		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident sustained multiple injuries while in care.
Staff did not prevent inappropriate interactions between residents in care.
Staff did not accord resident dignity while in care.

INVESTIGATION FINDINGS:

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In conjunction to complaint control # 31-AS-20250929135423, Licensing Program Analyst (LPA) Michael Cava conducted a subsequent complaint visit to the facility to conclude the investigation regarding the above allegations. The initial visit was made by Licensing Program Analyst (LPA) Mariana Agban on 06/26/25. During this visit, LPA met with the assistant administrator, Edwin Sanchez, and advised him of the complaint. LPA’s investigation consisted of interviews with staff and residents, a physical plant inspection, and record review.

Resident sustained multiple injuries while in care:
In regards to the allegation, it’s being reported that due to a lack of supervision, Resident 1 (R1) sustained unexplained injuries, presumably caused by another resident or staff. There were no witnesses identified to confirm this allegation. Moreover, R1 is diagnosed with a disease that makes them unable to provide an explanation of what happened to cause the injury.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

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-20250620115653

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: 10/01/2025

NARRATIVE

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At approximately 11:45am to 12:30pm LPA conducted interviews with six (6) of six staff, who were unable to confirm the allegation. From 12:30pm to 1:30pm LPA conducted interviews with six (6) of six residents. Due to the diagnosis of these residents, they were unable to confirm if the facility provides adequate supervision. From 1:30pm to 2:15pm, a physical plant inspection was conducted. There are surveillance cameras observed in common areas of the facility, which is a one story building, licensed to serve a capacity of 98 non-ambulatory residents. The facility also has an approved delayed egress. During the physical plant inspection, LPA observed six staff on duty, which include LVN, Residential Care Specialists, Office Manager, House Keeping and Kitchen staff.

Based on the information obtained, there wasn’t enough evidence to prove a resident’s injury was a result of a lack of supervision. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff did not prevent inappropriate interactions between residents in care:
In regards to the allegation, it’s being reported that on or around April 2024, because of inadequate staffing at the facility, Resident 2 (R2) struck and attacked R1. Law enforcement was notified and responded to a report describing battery. Their report gave no indication or conclusive evidence that there was a lack of supervision. Surveillance video was reviewed and it was observed that Staff 1 (S1) intervened immediately to redirect both residents.

At approximately 11:45am to 12:30pm LPA conducted interviews with six (6) of six staff, who were unable to confirm the allegation. From 12:30pm to 1:30pm LPA conducted interviews with six (6) of six residents. Due to the diagnosis of these residents, they were unable to confirm if the facility provides adequate supervision. From 1:30pm to 2:15pm, a physical plant inspection was conducted. There are surveillance cameras observed in common areas of the facility, which is a one story building, licensed to serve a capacity of 98 non-ambulatory residents. The facility also has an approved delayed egress. During the physical plant inspection, LPA observed six staff on duty, which include LVN, Residential Care Specialists, Office Manager, House Keeping and Kitchen staff.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250620115653

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: 10/01/2025

NARRATIVE

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Although the police report showed evidence of R2 attacking R1, there was insufficient evidence to conclude that this was a lack of supervision on the day this incident occurred as S1 was shown to intervene immediately to redirect both residents. Moreover, interviews made with both staff and residents do not corroborate with the allegation. Therefore investigation is Unsubstantiated at this time.

Staff did not accord resident dignity while in care.
In regards to the allegation, it’s being reported that on or around 04/26/25, there was a male individual, verbally abusing R1. There was no indication if this individual was a staff or resident. There also was no witnesses identified to corroborate with the allegation.

At approximately 11:45am to 12:30pm LPA conducted interviews with six (6) of six staff, who were unable to confirm the allegation. From 12:30pm to 1:30pm LPA conducted interviews with six (6) of six residents. Due to the diagnosis of these residents, they were unable to confirm any personal rights violation. During the physical plant inspection, LPA observed six staff on duty, which include LVN, Residential Care Specialists, Office Manager, House Keeping and Kitchen staff. LPA did not observe any personal rights violation during this walk through of the facility.

Based on the information obtained, it could not be proven that staff do not accord the resident’s dignity while in care. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 10/01/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

LIC9099 (FAS) - (06/04)

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