197608506-5-5-2021-28-AS-MVAO-C2QRL8-20210505130643

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 09/29/2020
Date Signed: 05/05/2021 12:25:31 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
07/17/2020 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200717153028

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: 71	DATE:	09/29/2020
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Leticia Flores		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility's assisted living shower area is in disrepair.
Facility staff handle and misplace residents' mail.

INVESTIGATION FINDINGS:

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**This is an amended version of the report dated 9/29/2020 to correct the community shower room number.**

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent complaint visit to deliver the findings for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Leticia Flores, the General Manager.

During the initial visit on 7/21/20, LPA Chan obtained copies of the following: Resident and Staff rosters, Staff morning shower/bathing/laundry assignments, plus the Face Sheet and Physician's Report for 5 residents. LPA conducted a virtual tour of the lobby where residents' mailboxes are located and shower areas in rooms #62 and #78. LPA also interviewed the General Manager, Staff #1 (S1) through Staff #5 (S5). LPA Chan conducted additional interviews with Residents #1 - #8 (R1 – R8) and Staff #6 and #7 (S6 – S7) on different dates.
(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

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-20200717153028

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: 09/29/2020

NARRATIVE

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Regarding allegation – Facility’s assisted living shower area is in disrepair. It is alleged that shower room was torn up and there were no prior verbal or written notification that the shower will be out of order. Per Administrator, Marina Pink, the community shower area was being renovated from 7/20/20 to approximately 8/4/20 to replace tiles and repaint the room. She also stated that the renovation did not require a permit and residents who uses the community shower room were verbally informed of the renovation. LPA confirmed with the Glendale Building and Safety Department that a permit is not require for this remodeling. During the virtual tour on 7/21/20, LPA Chan observed the shower room #78 (also known as the community shower room) to be under renovation. The tiles from the shower walls were removed and tiles on the floor partially removed. Per staff interviewed, the community shower room is always locked and is commonly used to shower/bathe residents who require assistance or in wheelchair as it is more spacious. They also stated that they verbally informed residents about the temporary non-usage of the community shower room due to it being under renovation. Since every resident’s room has a shower or tub in the room, some had opted to shower in their own rooms while others chose to temporarily use another shower room until the remodeling is completed. Based on interviews with residents, they all stated that were provided with the options of showering in their rooms or in the alternate shower room. Although the shower area was not operable due to renovation, the facility had provided other options to accommodate residents.

Regarding allegation – Facility staff handle and misplaces resident’s mail. The receptionist stated that due to the current COVID-19 pandemic, the mailman drops off all the mail by the front door instead of sorting out the mail in the residents’ mailboxes. The receptionist stated that she picks up the mail and sorts them daily. Another Staff or herself will either deliver the mail to the residents’ rooms or the residents will come to the front desk to pick up themselves. Receptionist also stated that there had been about 2 times when the mailman did not drop off mail or had dropped off as late as 8pm due to shortage of postal staff. Based on interviews with residents, 7 out of 8 did not have any issues with the mail.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

A telephonic exit interview was conducted with Leticia Flores, and a hard copy was provided via email for a signature.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2021

LIC9099 (FAS) - (06/04)

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