197608506-8-31-2021-28-AS-CYEE-C7FTWA-20211003150514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 08/31/2021
Date Signed: 08/31/2021 04:59:50 PM

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
06/14/2021 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210614095847

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: 65	DATE:	08/31/2021
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Rachel de Chavez, assistant administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility staff stole resident's valuable items

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicole Spencer conducted a subsequent visit to deliver the findings for the allegation listed above. LPA Spencer met with assistant administrator Rachel de Chavez and explained the purpose of today's visit.

The investigation consisted of the following: During the initial visit on 6/21/21, LPA Spencer took a tour of the physical plant and interviewed staff #1-3 (S1-S3) and residents #1-7 (R1-R7). During subsequent visit on 8/31/21, LPA interviewed staff #4-5 (S4-S5). LPA received copies of the staff roster, resident roster, theft and loss policy, and for R7: physician’s report, individual service plan (ISP), personal property inventory list and incident reports from May-July 2021.

See LIC9099C for continuation of this narrative.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

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-20210614095847

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: 08/31/2021

NARRATIVE

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The investigation revealed the following:

It was alleged that a staff member stole a resident’s valuable items including a ring, cashmere sweater, purse, glasses, makeup, and clothing. All staff interviewed denied the allegation but stated that they were aware of R7’s accusation of stolen items. Staff stated that each time a missing item is reported, it is documented on an internal incident report and searched for by staff. If not found, security footage is reviewed to see who went into the resident’s room. A review of the facility’s theft and loss policy shows that the facility maintains a personal property inventory list for each resident. R7’s personal property inventory lists the ring, cashmere sweater, purse, glasses, and clothing. Staff stated that they later found some of the items in the resident’s room.

7 out of 7 residents interviewed stated that they have not personally witnessed staff stealing items. 5 out of 7 residents stated that they have had items that went missing at the facility, with 4 of the 5 stating clothing items. S5, staff member in charge of laundry services, stated that all resident clothes are labeled and washed separately to prevent loss. S5 stated that residents have not recently complained about missing clothing, but if they do, staff will help residents look for it. Staff stated that many of the residents have memory problems and misplace items that are later found. A review of R7’s incident reports reveal that items were found in the resident’s room and/or checked by camera footage to ensure that no one entered the room.

Based on interviews and records reviewed, 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.

An exit interview was conducted and a copy of the report was provided to the assistant administrator.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021

LIC9099 (FAS) - (06/04)

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