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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608505
Report Date: 04/10/2026
Date Signed: 04/10/2026 02:52:17 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
06/06/2025 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20250606101944
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: 61DATE:
04/10/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Susan ParkTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility Staff did not provide resident with their medical device.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with Susan Park and explained the reason for the visit.

--- Facility Staff did not provide resident with their medical device.

It was alleged that facility is not giving Resident #1 (R1) their sleep apnea machine which they have a prescription for. To investigate the allegation, To investigate the allegation, on June 12, 2025, LPA Melissa Spaeth interviewed three (03) staff and seven (07) residents from around 11:20a.m. to 1:15p.m. LPA was unable to interview R1. To further investigate the allegation, on November 13, 2025, LPA contacted Local Ombudsman office. On April 10, 2026, LPA requested additional documents.

(CONT on LIC9099-C), Executive Director did not agree with statement and does not wish to sign.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026
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 5
Control Number 31-AS-20250606101944
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: 04/10/2026
NARRATIVE
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During interviews, all staff stated R1 does not know how to operate the Continuous Positive Airflow Pressure (CPAP) machine so R1 is not using it. S1 and Staff #2 (S2) added that R1 has memory issues and cannot follow directions to use the CPAP. During interviews with residents, all interviewed residents confirmed they do not use such medical devices. A review of Physician’s Report states R1 has a primary diagnosis of Dementia. R1 had no known allergies, confused/disoriented, sundowning behavior, able to follow instructions and communicate their needs. R1 is not able to administer own medications, administer own oxygen or store own medications. The Local Ombudsman stated they were not given authorization to release the information to the LPA.

Based on interviews, there is enough information to verify the allegation, therefore, the allegation is SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.

Executive Director did not agree with statement and does not wish to sign.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20250606101944
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: 04/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/13/2026
Section Cited
CCR
87619(b)(1)(2)
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87619 Intermittent Positive Pressure Breathing (IPPB) Machine (b) In addition to Section 87611(b), the licensee shall be responsible for the following: (1)Monitoring of the resident's ongoing ability to operate the equipment in accordance with the physician's orders. (2)Ensuring that the procedure is
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Licensee will review regulation CCR Title 22 87619 and submit a written letter stating they have reviewed the regulation and going forward will adhere to it by the POC due date.
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administered by an appropriately skilled professional should the resident require assistance. This requirement is not met as evidenced by; Based on interviews, all staff stated R1 does not know how to operate the CPAP so R1 is not using it. S1 and Staff #2 (S2) added that R1 has memory issues and cannot follow directions to use the CPAP which poses a potential health, safety and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
06/06/2025 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20250606101944

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: 61DATE:
04/10/2026
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Susan ParkTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility Staff gave medication without consent.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to this facility to investigate the above allegations. LPA met with Susan Park and explained the reason for the visit.

--- Facility Staff gave medication without consent.

It was alleged that responsible party became aware of R1 having a psych evaluation done where R1 was prescribed two (02) new medications without their consent. It was also reported medication Keppra and Depakote were given at the same time for the seizures. To investigate the allegation, To investigate the allegation, on June 12, 2025, LPA Melissa Spaeth interviewed three (03) staff and seven (07) residents from around 11:20a.m. to 1:15p.m.
(CONT on LIC9099-C)

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20250606101944
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: 04/10/2026
NARRATIVE
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LPA was unable to interview R1. To further investigate the allegation, on November 13, 2025, LPA contacted Local Ombudsman office. On April 10, 2026, LPA requested additional documents. During interviews, all staff stated all medications are given as prescribed by the physician and all residents have signed consent. During interviews, all residents stated staff have never given them medication that was not prescribed to them. A review of the Medication Administration Records indicates during the time in question resident was taking Levetiracetam/Keppra twice daily for seizures. The Medication Administration Records did not indicate R1 was taking Depakote/Divalproex Sodium/Valproate Sodium or any other medication for seizures. A review of the Centrally Stored Medication and Destruction Record does not show R1 had the alleged Depakote/ Divalproex Sodium/Valproate Sodium centrally stored with the facility. A review of R1’s records shows R1 or their responsible party signed the Consent to a Medical Examination, Consent for Emergency Medical Treatment, and Release of Client/Resident Medical Information forms. The Local Ombudsman stated they were not given authorization to release the information to the LPA.

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

No health and safety hazards noted during the visit.

Exit interview conducted. Copy of this report issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 04/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5