197608505-2-2-2026-31-AS-MGFS-DS5RX7-20260313132415

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 02/02/2026
Date Signed: 02/02/2026 04:39:56 PM

Substantiated

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
01/29/2026 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20260129081307

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:	02/02/2026
		UNANNOUNCED	TIME BEGAN:	10:40 AM
MET WITH:	Susan Park - Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff handled resident in a rough manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced initial complaint visit to investigate the above allegation. LPA met with the administrator Susan Park who granted access. Shortly after LPA met with the Assistant Administrator, Christopher Redmond, and explained the reason for the visit.

Allegation: Staff handled resident in a rough manner. It was alleged that on 01/25/2026, Resident #1 (R1) struck a staff member on the face and staff retaliated by aggressively grabbing and shaking R1's arm, then throwing a blanket over the resident’s face and body. To investigate the allegation, on 02/02/2026, LPA obtained copies of the Personnel Report (LIC 500) and the Client Roster. At 11:05 a.m., LPA initiated a physical plant tour of the facility to ensure the health and safety of residents in care. Between 11:15 a.m. and 2:00 p.m., LPA conducted interviews with seven (7) residents, of which two (2) did not respond to LPA’s questions, as well as interviews with three (3) staff members and the assistant administrator. At 12:15 p.m., LPA reviewed and obtained a copy of the video footage related to the incident. (Continue to LIC9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2026

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-20260129081307

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: 02/02/2026

NARRATIVE

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(Continued from LIC9099)
At approximately 2:25 p.m., LPA reviewed and obtained copies of the following documents, including but not limited to: R1’s Physician’s Report, R1’s Appraisal, Staff #1’s (S1) job application, S1’s training records, and the Unusual Incident Report and SOC 341 the facility submitted to Community Care Licensing.

R1 was not at the facility during todays visit. LPA's interviews with five (5) residents denied they had been treated roughly by staff members. LPA's interview with Staff #3 (S3) revealed R1 reported the incident to them. S3 then reviewed the video from that day and reported the incident to the assistant administrator. During LPA's interview with Staff #2 (S2) they stated they were asked to assist S1 with transferring R1 from the couch to a wheelchair, but did not witness, "R1 hit S1 or S1 hit R1 back" they maintained they did not witness either interaction and if S1 grabbed R1 it was without intention and without pressure. LPA's interview with S1 denies they handled R1 in a rough manner. According to S1 they held R1's arm down to prevent R1 from hitting staff or the other resident and they meant to "toss" the blanket to couch behind the client. LPA’s review of the video shows S1 and S2 struggling to assist R1 from the couch to a wheelchair, attempting at least three times before successfully placing R1 in the wheelchair. R1 is seen striking S1 in the face, after which S1 approaches R1 and grabs R1 by the right arm, because another resident stands in front of S1 and R1, LPA could observe R1’s head from side to side and part of R1's arm movement. S2 then tosses a blanket to R1, and R1 throws the blanket to the floor. S1 picks up the blanket from the floor and throws it over R1’s head and body before walking out of the room. R1 removes the blanket, and another resident is seen grabbing the blanket and shoving it onto R1’s face. S2 stops the interaction between R1 and the other resident, and then wheels R1 out of the room. According to the assistant administrator S1 was placed on Administrative leave pending an investigation and has been terminated as of 02/02/2026.

Based on interviews conducted and video observed, this allegation is deemed SUBSTANTIATED at this time.

Deficiency cited (refer to LIC9099-D). Exit interview conducted. Appeal Rights provided. A copy of the report was issued.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2026

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20260129081307

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/02/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 02/03/2026 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	(a)...residential care facilities for the elderly shall have all of the following personal rights: (8) To be free from neglect, financial exploitation, involuntary seclusion, punishment, humiliation, intimidation, and verbal, mental, physical, or sexual abuse.	1 2 3 4 5 6 7	S1 was terminated as of 02/02/2026. Administrator will start in service training for all staff regarding residents rights and mandated reporting. Administrator will provide a copy of the material and sign in sheet to LPA by POC date 02/03/2026.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: Based on interviews conducted and video reviewed by LPA, R1 was handled in a rough manner by S1 which posed an immediate health and safety or personal rights risk to clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2026

LIC9099 (FAS) - (06/04)

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