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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 05/13/2026
Date Signed: 05/13/2026 01:12:14 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
03/26/2026 and conducted by Evaluator Angelica Segovia
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20260326152151
FACILITY NAME:GLEN PARK AT GLENDALE - BOYNTON STFACILITY NUMBER:
197608505
ADMINISTRATOR:SUSAN PARKFACILITY TYPE:
740
ADDRESS:1250 BOYNTON STTELEPHONE:
(818) 246-9000
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:98CENSUS: 58DATE:
05/13/2026
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Susan Parks- AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff are not following physician’s order for resident’s medical needs.
INVESTIGATION FINDINGS:
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On 5/13/2026 at approximately 9:30 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced subsequent complaint visit to the facility. LPA was greeted by the Administrator, Susan Park and stated the reason for their visit.

To investigate the allegation(s), at approximately 10:00 AM, LPA conducted a physical plant tour. By 11:00 AM, LPA requested relevant documentation such as but not limited to: Physician’s Reports, Needs/Services, and Physician’s Orders. From 11:30 AM to 2:30 PM, LPA attempted to interview one (1) resident (R1), two (2) staff members (S1-S2) and conducted record review.


(Continue to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20260326152151
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: 05/13/2026
NARRATIVE
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Regarding the allegation: Staff are not following physician’s order for resident’s medical needs. It was alleged staff did not follow R1’s physician’s orders pertaining to their walker. To investigate the allegation, LPA attempted to interview one (1) resident and two (2) staff members. LPA attempted to interview R1, but they no longer reside at the facility. LPA’s interview with S1 revealed R1 moved out of the facility into a smaller facility due to them needing a higher level of care. S1 stated, R1’s representative did not choose to pay for optional services such as one (1) to one (1) Supervision Program. Per S1, R1’s cognitive impairments had resulted in an increase in falls and although they had a walker they would forget to use it. LPA’s interview with S2 correlated with S1’s interview. S2 stated they self-reported R1’s falls on an Unusual Incident/Injury Reports (SIRs).

LPA conducted a record review of R1’s file. LPA’s record review of R1’s Physicians Visit dated 3/24/2026 confirmed R1 to need their walker. R1’s initial Needs and Services Plan dated 8/29/2022 documented R1 as ambulatory without needing assistance. However, R1’s Needs and Services Plan dated 4/12/2026, documented their change of condition to reflect their need of a walker and in need of supervision due to their inability to follow instructions. R1’s Physician’s Report dated 2/18/2026 confirmed R1 could not follow directions/instructions due to their diagnosis. LPA’s record review confirmed the facility did report R1’s falls to the appropriate reporting parties including Community Care Licensing Division (CCLD). Additionally, LPA’s review of R1’s Admission Agreement confirmed they did not have Optional Items and Services to be notated. Further record review of R1’s Notice of Resident Moving Out dated 4/15/2026 documented their reason of moving as, “Higher level of care”.

During LPA’s physical plant tour, LPA observed a variety of residents to be using assistances devices to ambulate such as walkers. Additionally, LPA observed a variety of staff members assisting residents to the common areas, food preparation and medication.

Based on interviews, record review and observations there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No immediate health and safety issues observed during the day of the visit. Exit interview was conducted and a copy of this report was provided to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026
LIC9099 (FAS) - (06/04)
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