197608505-1-12-2026-31-AS-TAGD-DQZU8Y-20260205142215

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 01/12/2026
Date Signed: 01/12/2026 12:20:33 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
01/07/2026 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20260107164256

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: 63	DATE:	01/12/2026
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Christopher Redmond, Assistant Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Factility staff are not releasing resident's records to legal representative

INVESTIGATION FINDINGS:

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On 01/12/26, at 9:25am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, initial complaint visit and was greeted by Christopher Redmond-Assistant Administrator. LPA explained the purpose of this visit was to gather information, interview staff and residents and deliver findings for this complaint.

On 01/12/26, LPA Saucedo asked for the census, staff, and resident rosters. On 01/12/26, at 9:55am, LPA Saucedo conducted a physical tour. On 01/12/26, at 10:15am, LPA Saucedo started to conduct resident and staff interviews.

LIC 9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

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-20260107164256

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: 01/12/2026

NARRATIVE

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Regarding the allegation: Facility staff are not releasing resident's records to legal representative. It is being alleged that Resident #1 (R1)’s entire file has been requested, there have been six (6) attempts and there has been no release of R1’s records to legal representatives. During LPA’s pre-investigation, LPA received a HIPPA-(Health Insurance Portability and Accountability Act) Compliant Medical Authorization signed and dated by R1's son on 06/16/23 with no notarization and an Advanced Health Care Directive stating R1's son is Power or Attorney for Health Care signed and dated and notarized on May 04, 2017, including R1's signature in 2016. The Advanced Health Care Directive lists two (2) other of R1's sons for Power of Attorney but it does not list any legal representatives as Power of Attorney to receive records. There have been no documents provided to show any type of consent-(form LIC 605A) for the Release of Client/Resident Medical Information to legal representatives besides the Power of Attorney. LPA did speak to R1's Power of Attorney and they did state, "that no paperwork has been updated to show records can be released to others." The LIC 605A was signed on 10/26/23 by R1's son for the Release of Client/Resident Medical Information. LPA attempted to interview R1 but to no avail was R1 responding to LPA's question. Let it be noted, R1 is currently diagnosed with Dementia per their Physician's report and Resident Appraisal. LPA interviewed two (2) staff that confirmed they did receive information from legal representatives to receive R1's file but R1's Power or Attorney for medical records never requested such information and never updated the LIC 605A form to let anyone else receive R1's records. In addition, the person's that were requesting R1's records are not listed on R1's Identification and Emergency Information. LPA reviewed and obtained the following documents regarding R1-Physician's report and Resident Appraisal, LIC 605A, Identification and Emergency Information, Admission Agreement, Personal Rights all signed by R1's son-Power of Attorney. Therefore, based on the record reviews and interviews conducted, the allegation is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citation(s) were issued for the above allegation(s), and a copy of this report was given to the Assistant Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

LIC9099 (FAS) - (06/04)

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