197608506-9-20-2021-28-AS-CYEE-C8N3B3-20211110170537

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 09/20/2021
Date Signed: 09/20/2021 02:48:07 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
09/13/2021 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210913134558

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: 64	DATE:	09/20/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Rachel De Chavez		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are not assisting residents with voting

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Assistant Administrator Rachel De Chavez and explained the reason for the visit.

The investigation consisted of: LPA collected copies of Staff and Resident Rosters, conducted interviews with Assistant Administrator Rachel De Chavez at 10:15am -10:30am, Office Manager Leticia Flores at 10:45am, Receptionist Siranush Aleksanyan at 11:00am, Activity Director Shirley Lee at 11:15am and Residents 1-7 (R1-7) from 11:30-12:30pm.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

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-20210913134558

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: 09/20/2021

NARRATIVE

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Investigation revealed the following: Regarding allegation, Staff are not assisting residents with voting, it is alleged that facility staff are not assisting R1 with getting their ballot in for the Gubernatorial Recall Election. Staff have allegedly told R1 that they would help but have kept putting resident off and resident is afraid of not getting their vote in on time. Interviews with facility staff revealed that they did assist residents with their ballots for the Gubernatorial Recall Election if they requested assistance. Facility staff stated that residents who chose to vote by mail got their ballots ready and dropped them off at the reception desk to be mailed out. Staff also stated that the facility also provided transportation to any resident that wished to vote in person at their assigned voting poll location. Interview with R1 revealed that they voted in person and that the facility provided them with transportation to their voting poll location. R1 stated that staff did provide assistance and were helpful regarding making sure they voted. R1 stated that they have no current concerns regarding the facility. 3 out of 7 residents that were interviewed stated that facility staff did assist them with voting by either making sure their ballots were mailed out on time or providing transportation to poll location. 4 out of 7 residents that were interviewed stated that they did not request assistance from staff regarding voting as they chose not to vote.

Based on interviews conducted with facility staff and residents, there was not enough supportive evidence to concur with the reported 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.

Exit interview held. A copy of the report was provided to Assistant Administrator Rachel De Chavez.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2021

LIC9099 (FAS) - (06/04)

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