197608506-11-18-2021-28-AS-LHIS-C9HVFA-20211208152336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 11/18/2021
Date Signed: 11/18/2021 04:37:47 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
11/16/2021 and conducted by Evaluator Noemi Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211116162531

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: 63	DATE:	11/18/2021
		UNANNOUNCED	TIME BEGAN:	12:57 PM
MET WITH:	Marina Pink, Administrator		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Resident was not accorded dignity in their personal relationships with staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Galarza conducted an initial complaint visit to investigate the above allegation. The purpose of the visit was discussed with Administrator Marina Pink.

The investigation consisted of the following: A physical plant tour of the facility, record review, staff (S1- S6), and residents (R1- R8) were interviewed. Resident (R1's) file was reviewed and documents [Admission Agreement, Face Sheet, Appraisal/Needs and Services Plan, Physician Report, Individual Service Plan (ISP), Resident Appraisal, Functional Capability Assessment, incident reports,bathing schedule, staff roster, and resident roster ] were obtained. No health and safety issues were observed during the visit.

See LIC 9099C for report continuation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

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-20211116162531

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: 11/18/2021

NARRATIVE

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Allegation: "Resident was not accorded dignity in their personal relationships with staff." Based on interviews conducted and record review the findings indicate that facility staff have not caused emotional distress or harassed resident (R1) about hygiene, sponge baths, and cultural background. It is alleged that facility staff communicated communicated to a third party health professional that the resident is not sponge bathing itself. The facility provides shower assistance to residents twice a week, and/or more if needed due to incontinence issues. On the days that residents do not receive a shower they are sponge bathe by staff. Resident (R1) refuses shower assistance and sponge baths. Therefore is not on the facility bathing schedule. Per record review, resident (R1) can bathe itself without assistance. It was noted that the resident is at times disoriented and confused due to health diagnosis. Resident (R1) confirmed refusal of bathing assistance, and stated it bathes and/or washes hair regularly on its own. Resident (R1) stated there are possible cultural differences in hygiene practices.

Six (6) out of six (6) staff denied allegation and stated that resident (R1) has good hygiene and is able to perform own bathing. Two (2) out eight (8) residents stated that staff have harassed them and were not treated with dignity during bathing assistance. A resident stated that caregiver staff rush bathing sessions and ask the resident to quickly get out of the shower with soap still in some body parts. Six (6) out of eight (8) residents stated they are treated well by staff and do not feel harassed or mistreated. There is insufficient supportive evidence to concur with the reported allegation.

Based on interviews conducted, records reviewed, and LPA observations there is insufficient information 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(s) did or did not occur, therefore the allegation is Unsubstantiated.

Exit interview conducted with Administrator Marina Pink. A copy of the report was provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi Galarza	TELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021

LIC9099 (FAS) - (06/04)

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