197608506-12-8-2020-28-AS-MVAO-BXURXA-20210202122424

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 12/02/2020
Date Signed: 12/08/2020 11:41:29 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2020 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200825141253

FACILITY NAME:	GLEN PARK AT GLENDALE - MARIPOSA ST		FACILITY NUMBER:	197608506
ADMINISTRATOR:	PINK, MARINA		FACILITY TYPE:	740
ADDRESS:	1220 S MARIPOSA ST		TELEPHONE:	(818) 242-9000
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	120	CENSUS: 62	DATE:	12/02/2020
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Marina Pink, Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Residents are being mistreated by staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Marina Pink, facility Administrator.

During the initial visit on 9/1/20, LPA obtained the Resident roster and Staff roster which includes the contact information. LPA interviewed Staff #1 - #3 (S1 - S3) telephonically. LPA Chan received a copy of the Staff In-Service Training on Personal Rights on 9/2/20. LPA conducted additional interviews with staff and 8 residents telephonically on 10/19/20.

Regarding allegation – Residents are being mistreated by staff. It is alleged that staff physically abuses residents and denies residents their rights.
(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020

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 28-AS-20200825141253

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST	FACILITY NUMBER: 197608506
	VISIT DATE: 12/02/2020

NARRATIVE

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Based on interviews conducted, all the staff stated that they had training on Resident’s Personal Rights. They are trained to treat residents with respect and do not force residents to do things. They do not talk back, yell, nor talk down to residents. Staff interviewed stated that they have not witnessed any physical or verbal abuse coming from other staff. Some said that they are mandated reporters so if they have seen any abuse, they will report right away. Per Administrator, she has not heard or seen any staff mistreating residents. LPA interviewed 8 residents and they stated that the staff are good, nice, and/or helpful. 7 out of 8 stated that they have not seen or heard any staff physically abusing residents or mistreating them. One of the resident was unable to provide any details regarding an alleged hit. Based on the information gathered, there is insufficient evidence to support the allegation.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

A telephonic exit interview was conducted with the Administrator. A hard copy was provided via email for the signature along with the Appeal Rights.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2020

LIC9099 (FAS) - (06/04)

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