197608506-3-30-2022-28-AS-LHIS-CEHFBW-20220517042125

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 03/30/2022
Date Signed: 03/30/2022 03:47:59 PM

Unsubstantiated

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
03/24/2022 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220324093208

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: 65	DATE:	03/30/2022
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Rachel De Chavez, Assistant Administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff do not meet the residents dietary needs.
Staff do not provide adequate care and supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegations listed above. LPA met with Assistant Administrator, Rachel De Chavez, and explained the purpose of the visit.

The investigation consisted of the following:
LPA obtained copies of the staff roster, resident roster, food menu, staff schedule and duties, list of diabetic residents, and a resident tracking sheet. A tour of the dining room and kitchen was conducted with Staff. LPA also interviewed 6 Staff and 7 Residents today.

The investigation revealed the following:
Regarding allegation - Staff do not meet the residents dietary needs. The facility has started a seasonal menu which began on March 6, 2022 and menu will change every quarter. Per the Administrator, the food menu is created by a licensed dietitian from the New Menus Solution Company, who looks at the dietary needs of residents on low sodium, low carbs, and/or those with diabetes.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

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-20220324093208

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: 03/30/2022

NARRATIVE

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The food menu is also inspected by a state dietitian from the Dietitian of Orange County. LPA reviewed the food menu and appear to be nutritional with items from each food group. For lunch and dinner, the chef cooks 2 different plates in which residents may choose from. There are other options available if residents do not like what is on the menu. The daily menu is available and posted in the dining room and weekly menu can be obtained in the front desk. LPA toured the dining room and kitchen during the lunch hour and observed adequate servings with additional options in the kitchen. Three (3) out of Seven (7) residents interviewed stated the food do not seem to fulfill the dietary needs of residents. They feel there are too much carbs and/or not enough selections. Staff interviewed have not heard of residents complaining about the meals except for one.

Regarding allegation - Staff do not provide adequate care and supervision. Based on interviews with Staff, they feel there is adequate care and supervision provided to residents. The caregivers stated they have walkie-talkie in which the front desk will page them when a resident pulls the call light in their rooms. They will assist residents as soon as they could and will inform residents when they are assisting another person to wait a few minutes. They also stated that they check on residents every 2 hours and are documented on the residents' tracking sheet. LPA obtained and reviewed the one of the residents tracking sheet on each shift as a sample of their documentation. The facility also has video surveillance in the common areas and hallways for additional supervision. Four (4) out of Seven (7) residents feel there are adequate staffing and staff provide good care and meet their needs.

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 allegations are UNSUBSTANTIATED.

An exit interview was conducted with the Assistant Administrator. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2022

LIC9099 (FAS) - (06/04)

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