197608505-5-13-2026-31-AS-MGFS-DWHV4P-20260731160637

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 05/13/2026
Date Signed: 05/13/2026 02:42:33 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
08/11/2025 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20250811124846

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: 58	DATE:	05/13/2026
		UNANNOUNCED	TIME BEGAN:	10:32 AM
MET WITH:	Susan Park- Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff use inappropriate restraints on residents.
Staff do not treat residents with dignity and respect.
Staff mismanage residents medication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced subsequent visit for the above allegation. LPA met with the executive director (S1), Susan Park, and explained the reason for the visit.

On 08/18/25 LPA Abgan conducted an initial investigation visit. On 5.13.2026, LPA toured the physical plant at 10:40 AM. At 10:45 AM, LPA interviewed the executive director (S1) and five (5) staff. At 11:45 AM, LPA interviewed and reviewed medication for six (6) residents. At 12:00 PM, LPA conducted a records review as well as other relevant documents, including the physician's report, LIC 500 (staff roster), resident roster, appraisal needs and service plan (LIC 625), medication administration record (MAR), centrally stored medication and destruction record (CSMDR), and other pertinent documents.

Allegation: Staff use inappropriate restraints on residents.
Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
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)

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Control Number 31-AS-20250811124846

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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It was alleged that staff are restraining resident#1-#2(R1-R2) physically or by removing the wheelchair to prevent them from being disruptive and residents are being chemically restrained with over-the-counter (PRN) medications. LPA record review today revealed a physician's order for a wheelchair for R1 and R2. LPA interview with staff revealed they never restrain residents, and R1/R2 were free to roam around the facility. Interview with residents revealed that they are not restrained and residents are assisted immediately when requested. R1 was not interviewed as they are no longer in the facility. During the physical plant tour of the facility conducted on 5.13.2026, LPA did not observe any residents being restrained chemically or physically and were happy roaming freely around the facility. Medications were stored centrally stored and medication review did not reveal PRN for restraining purposes.

Based on interviews, observation, and record reviews, there is no sufficient information to verify the allegation. Therefore, the allegation is unsubstantiated at this time.

Allegation: Staff do not treat residents with dignity and respect.

Regarding the above allegation, it is alleged that the facility staff slammed a resident into the bed and held the resident there. Interviews with residents revealed that they are happy with the care provided and have not experienced such treatment from staff. R1 was not interviews as they are no longer at the facility. Interviews with staff revealed that they treat all their residents with dignity and respect. Upon review of facility records, there was no information to support the allegation. LPA reviewed last personal rights training given to staff on 2.3.2026.

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

Allegation: Staff mismanage residents medication.

It was alleged that facility staff mismanage residents' medication by missing dosages and not giving the residents their medication in a timely manner. To investigate this investigation, LPA reviewed the Centrally Store Medication and Destruction Record (CSMDR) and Medication Administration Record (MAR) for 6 residents and did not observed discrepancies. Continue to LIC 9099-C

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
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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Control Number 31-AS-20250811124846

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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LPA reviewed the Medication Administration Record (MAR) for R1 and observed that from June 1, 2025, to November 2025, the resident's medication was given in a timely manner. All staff stated that residents always received their medication as prescribed by their physician. R1 would sometimes refuse to take their medication, but staff would try again later, and R1 would cooperate. Interview with residents revealed that they always get their medication as prescribed by their physician and that the staff gives it to them at the correct times. Residents have not been given medication to make them sleepy or keep them restrain.

Based on the information received and record review, this allegation is Unsubstantiated this time.

No health and safety issues were noted at the time of this visit.

An exit interview was conducted, and a copy of the report was provided.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
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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