197608506-11-24-2021-28-AS-CYEE-C96VJL-20211127152851

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 08/20/2021
Date Signed: 11/24/2021 03:16:15 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
12/17/2020 and conducted by Evaluator Linda M Almaraz

COMPLAINT CONTROL NUMBER: 28-AS-20201217072050

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:	DATE:	08/20/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Leticia Flores,		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff are abusing residents
Staff are stealing from residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst's (LPA's) Linda Almaraz and Luis Mora conducted a subsequent complaint visit to investigate the allegations listed above. LPA's met with Assistant Administrator Leticia Flores and explained the reason for today's visit.

The investigation consisted of the following: On 12/24/2020, LPA Almaraz interviewed Staff #1-2. On 8/20/2021, LPA's interviewed Flores, Staff #3-5 and requested a copy of staff and resident roster.

The investigation revealed the following: Based on interviews conducted with staff they have not seen any other staff be abusive to residents or towards residents. Staff also stated they have not heard or been told by residents that they are being mistreated or abused.

In regards to the allegation "Staff are stealing from residents," all interviews conducted stated they have not hear of any staff stealing from residents. ( Continued on an LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

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-20201217072050

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: 08/20/2021

NARRATIVE

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Staff stated there is a resident who is currently at a Skilled Nursing Facility (SNF) who is always stating things are missing and that someone is stealing from the resident. Per interview with staff, they always assist the resident and help the resident look for missing items and they find them. Interviews with residents stated they have not had anything stolen from them. One (1) out of seven (7) residents stated they go in the residents room and the resident could tell they have gone through the residents items but they have not stolen anything from the resident.

Based on LPA's interviews conducted, observations and records reviewed, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. An exit Interview was conducted with the Administrator and a hardcopy was provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M Almaraz	TELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2021

LIC9099 (FAS) - (06/04)

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