197608505-12-16-2025-31-AS-TAGD-DRSSSM-20260302130811

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 12/16/2025
Date Signed: 12/16/2025 12:01:48 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
11/20/2025 and conducted by Evaluator Gina Saucedo

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20251120120416

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:	12/16/2025
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Christopher Redmond, Assistant Administrator		TIME COMPLETED:	12:10 PM

ALLEGATION(S):

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Staff refused to accept resident back to the facility
Staff did not inform authorized representative of incidents

INVESTIGATION FINDINGS:

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On 12/16/25, at 9:25am, Licensing Program Analyst (LPA) Gina Saucedo arrived at the facility to conduct an unannounced, subsequent visit was greeted by Assistant Administrator, Christopher Redmond. LPA explained the purpose of this visit was to gather additional information, interview staff and residents and deliver findings for this complaint.

On 11/26/25, LPA Saucedo conducted the initial visit. On 11/26/25, LPA Saucedo asked for the census, staff, and resident rosters. On 11/26/25, LPA Saucedo conducted a physical tour and obtained the following documents regarding resident #1 (R1)’s-Pre-placement, Resident Appraisal, Functional Capability Assessment, Physician's Report and Appraisal/Needs and Services Plan. On 12/16/25, at 9:55am, LPA Gina Saucedo conducted another physical tour, interviewed additional staff and residents.

LIC 9099C-continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025

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-20251120120416

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: 12/16/2025

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. LPA received all unusual/incident reports that were sent to CCLD-Community Care Licensing Department in regards to R1’s falls and/or hospitalization. LPA interviewed three (3) staff that confirmed R1 returned to the facility more than once from the hospital. They have not refused R1 back into the facility at any time. One (1) staff did confirm that they spoke to someone at the hospital telling them that R1 will need a higher level of care because of the repetition of their falls and their concern for R1's safety. LPA also spoke to R1’s POA-Power of Attorney and the POA did confirm that the facility did mention a higher level of care because of R1’s falls and asked if R1 can have a 1:1 staff with them because R1 is now a fall risk and also confirmed with LPA that R1 was accepted back to the facility with no issues. During LPA’s physical tour on 11/26/25, R1 was at the facility and had just returned from the hospital a few days prior. LPA attempted to interview six (6) residents including R1 but to no avail none of the residents could understand what the LPA was asking and/or answer LPA's questions. Therefore, based on the LPA's record reviews, staff, resident and POA interviews conducted, the allegation is UNSUBSTANTIATED at this time.
Regarding the allegation: Staff did not inform authorized representative of incidents. It is being alleged that resident #1 (R1)’s power of attorney (POA) was not informed of R1’s incidents. LPA interviewed four (4) staff that confirmed that since R1’s admission to the facility was in October of 2025, R1 has fallen multiple times and has gone to the hospital twice. Four (4) staff confirmed that for every incident they have informed R1’s POA and doctor. LPA reviewed all unusual/incident reports that were sent to CCLD-Community Care Licensing Department in regards to R1’s falls and/or hospitalization and it shows POA and doctor were informed. LPA called R1’s POA to confirm if they were aware of R1’s incidents and R1’s POA confirmed that they were aware of R1’s incidents and hospitalization because the facility let them know and they also had visited R1 at the hospital. Furthermore, R1's POA also confirmed that the hospital called them since they were on R1's emergency paperwork to let them know R1 was at the hospital. LPA obtained R1's Identification and Emergency Information showing who is R1's guardianship. LPA attempted to interview six (6) residents including R1 but to no avail none of the residents could understand what the LPA was asking and/or answer LPA's questions. Therefore, based on the LPA's record reviews, staff, resident and POA interviews conducted, the allegation is UNSUBSTANTIATED at this time.

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

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Gina Saucedo
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2025

LIC9099 (FAS) - (06/04)

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