197608506-12-8-2021-28-AS-FFIS-C9Q4TT-20211214182338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 12/08/2021
Date Signed: 12/08/2021 05:09:57 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
11/29/2021 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20211129121019

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:	12/08/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Marina Pink, Administrator Rachel De Chavez, Assistance Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff does not treat residents with dignity and respect.
Staff threatens residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted an unannounced complaint visit in response to the above allegations. LPA met with Administrator, Marina Pink and Assistance Administrator, Rachel De Chavez who assisted with today's visit.

The investigation consisted of interviews with administrator, assistant administrator, staff #3 to staff #7, interviews with residents #1 to resident #7, and review of resident #1 files.

Regarding the allegation that Staff does not treat residents with dignity and respect, it was alleged that Staff#7 (R7) talk to Resident# 1 (R1) in a disrespectful manner. Per staff interviews, seven (7) of seven (7) staff denied the allegation. Staff interviews revealed staff treat residents with respect and dignity. Per resident interviews, seven (7) of seven (7) residents could not corroborate the allegation. LPA observed that staff treat residents with respect and dignity during the visit. (-continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021

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-20211129121019

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: 12/08/2021

NARRATIVE

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Review of staff training, staff received in-service training on resident’s right. 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.

Regarding the allegation that Staff threatens residents, it was alleged that S7 threatened R1. Per staff interviews, seven (7) of seven (7) staff denied the allegation. It revealed staff did not threat residents. Per resident interviews, seven (7) of seven (7) residents could not corroborate the allegation. They stated that they have not observed any resident(s) being threatened by staff. LPA did not observe staff threaten residents during the visit. Review of staff training, staff received in-service training on resident’s right. 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.

No Deficiencies cited under California Code of Regulations Title 22.

An exit interview conducted, and a copy of the report was provided to Assistance Administrator.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 12/08/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021

LIC9099 (FAS) - (06/04)

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