197608506-12-16-2021-28-AS-MVAO-CB3TYJ-20220127140849

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 12/16/2021
Date Signed: 12/16/2021 01:15:42 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
11/13/2020 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201113111739

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:	12/16/2021
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Rachel De Chavez		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff member inappropriately touched resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted a subsequent complaint visit to deliver investigation findings for the above stated allegation. LPA met with Assistant Administrator Rachel De Chavez and explained the reason for the visit.

The investigation consisted of: During the initial visit conducted on 11/16/20, LPA conducted a telephone interview with Office Manager Leticia Flores and also conducted a televisit via Facetime with Office Manager for the purpose of conducting a health and safety check. LPA Gonzalez and Office Manager Flores toured the facility. Health and safety check included a tour of the entire facility including lobby and dining room and a sample of resident rooms. LPA did not observe any signs of neglect, abuse or other immediate health and safety threats. LPA additionally requested and received copies of Staff and Resident Rosters. On 12/16/21, LPA Gonzalez interviewed Assistant Administrator Rachel De Chavez, Office Manager Leticia Flores and Licensee/ Administrator Marina Pink.

(See LIC9099C for continuation)

Unfounded

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: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

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-20201113111739

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: 12/16/2021

NARRATIVE

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LPA attempted to get in contact with North LA County Regional Center Service Coordinator. LPA also conducted a phone call with Assistant Director of CBEM, which is a Crisis Prevention and Intervention Service vendored by North LA County Regional Center. LPA additionally requested and received current resident and staff rosters and also copies of Resident Rosters for the months of September - November 2020.

Investigation revealed the following: Regarding allegation of, Staff member inappropriately touched resident, it is alleged that R1 was inappropriately touched by a male staff member in their private area. R1 was also having stomach related problems at the time. Interview with Assistant Administrator Rachel De Chavez revealed that R1 is not a resident of the facility. Interview with Office Manager Flores revealed that R1 has never been a resident of the facility. Interview with Licensee Marina Pink revealed that R1 has never been a resident of the facility. Licensee stated that R1 was a resident of Glen Park at Valley Village but moved out over a year ago. Licensee stated that she does not know where R1 moved to. She stated that R1 did not ever bring up any allegations of being inappropriately touched by a male staff while they lived at the facility. She stated that she was in communication with North LA County Regional Center Service Coordinator regarding R1 but not for the allegation of being inappropriately touched but for concerns regarding the dispensing of R1's Personal and Incidental monies during unscheduled time frames. LPA attempted to contact North LA County Regional Center Service Coordinator but did not receive a call back. LPA spoke to Assistant Director of CBEM, who confirmed that R1 was a resident of Glen Park at Valley Village. LPA review of resident rosters for the months of September - November 2020 revealed that R1 was not a resident of the facility.

Based on LPA interviews with Licensee, Office Manager and Administrator and LPA review of documentation which revealed that R1 is not a resident and has not been a resident of the facility, LPA Gonzalez determined that there was insufficient evidence to support the above stated allegation.

This agency has investigated the complaint alleging, Staff member inappropriately touched resident. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or are without reasonable basis. We have therefore dismissed the complaint.

Exit interview held. A copy of the report was provided to Licensee Marina Pink.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2021

LIC9099 (FAS) - (06/04)

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