197608505-2-3-2026-31-AS-TAGD-DRKNHB-20260223092827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 02/03/2026
Date Signed: 02/03/2026 03:31:52 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
08/21/2025 and conducted by Evaluator Nadia Shahbazian

COMPLAINT CONTROL NUMBER: 31-AS-20250821090734

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: 64	DATE:	02/03/2026
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Susan Park - Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff refused to accept resident back to the facility

INVESTIGATION FINDINGS:

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On 02/03/2026 at approximately 1:15pm, Licensing Program Analyst (LPA) Nadia Shahbazian arrived at the facility to conduct an unannounced, subsequent complaint visit. LPA was greeted by Susan Park - Executive Director and explained the purpose of this visit.

On 08/26/2025, LPA Shahbazian conducted the initial complaint visit. On 08/26/25, LPA Shahbazian had interviewed staff and gathered pertinent documents regarding the investigation. On 02/03/2026, at 1:30pm, LPA Shahbazian conducted a physical tour to ensure safety, no immediate health issues were observed.

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

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-20250821090734

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: 02/03/2026

NARRATIVE

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Regarding the allegation: Staff refused to accept resident back to the facility. It is being alleged that Resident #1 (R1) was not being accepted back to the facility. R1 was admitted to the facility with diagnosis of dementia and required Assistance of Daily Activities (ADLs). LPA was provided copies of several Unusual Incident/Injury Reports from 04/21/2025-05/28/2025, where R1 was involved in physical altercations with staff and residents, which presented health and safety threats. On 02/10/25 R1 was diagnosed with a condition requiring use of Continuous Positive Airway Pressure (CPAP) machine nightly. Administrator informed LPA that sometime in late April 2025 POA brought in a CPAP machine, without notifying the Administrator. POA trained a former Med Tech how to put on the mask on R1 and asked the staff to monitor R1 every two hours to ensure the mask is properly placed. In May 2025 Administrator had a Care and Service Meeting with POA. Additionally, Administrator informed POA that breathing machines are considered Restricted health conditions, which are against facility’s plan of operation. Administrator informed POA that R1 might perhaps need a higher level of care. On several occasions R1 was hospitalized. On one occasion, on 05/28/2025, POA discharged R1 from hospital, without approval from facility administrator and without providing discharge report. Facility served a 30 day eviction notice on 06/17/2025, with move out date of 07/17/2025, but R1 was not evicted. Administrator informed LPA that on 07/22/2025 POA took R1 to hospital due to fever and R1 was hospitalized. Facility staff visited R1 in the hospital on 08/19/2025 and evaluated R1. It was observed that R1 is using CPAP machine in the hospital. Additionally, hospital report obtained, also states that resident has sleep apnea and requires continued use of CPAP machine at nights.

Based on interviews and record review, it was determined that POA was informed of R1’s possible need for higher level of care due to behavioral issues and CPAP machine. R1 was served 30 day eviction notice on 06/17/2025. Due to higher level of care, facility is unable to provide such care, therefore the allegation is UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of the report was issued.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Nadia Shahbazian
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

LIC9099 (FAS) - (06/04)

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