197608506-4-6-2022-28-AS-LHIS-CEHFSM-20220517044458

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 04/06/2022
Date Signed: 04/06/2022 04:32:58 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
03/29/2022 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220329161435

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:	04/06/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Marina Pink and Rachel De Chavez		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Administrator does not ensure a safe and healthful environment for residents
Financial abuse
Administrator is retaliating against a resident
Staff do not assist residents with incontinence needs
Resident do not get enough to eat
Staff do not provide snacks to residents
Staff do not afford resident confidentiality
Staff do not safeguard residents property

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

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

Regarding the allegation that Administrator does not ensure a safe and healthful environment to residents, the investigation consisted of interviews with Administrator, Assistant Administrator, Staff #1 and Resident #1- Resident #6. Administrator and staff interviewed denied the allegation. They stated that the facility does ensure a safe and healthful environment for residents. Residents interviewed were unable to corroborate the allegation. 5 out of 6 residents stated that the environment at the facility is safe and healthful. Regarding the allegation of financial abuse, the investigation consisted of interviews with Administrator, Assistant Administrator, Staff #1 and Resident #1- Resident #6. Adminstrator and staff interviewed denied the allegation. They stated that resident #1 has a balance that is overdue, and they have provided resident #1 with documentation of the amount that is overdue. Residents interviewed were unable to corroborate the allegation. 6 out of 6 residents stated that they have not experienced financial abuse at the faciilty.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 28-AS-20220329161435

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: 04/06/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation that the Administrator is retaliating against a resident, the investigation consisted of interviews with Administrator, Assistant Administrator, Staff #1 and Resident #1- Resident #6. Administrator and staff interviewed denied the allegation. They stated that Administrator is not retaliating against any resident at the facility. Residents interviewed were unable to corroborate the allegation. 5 out of 6 residents stated that they were not aware that Administrator is retaliating against any resident(s) at the facility.

Regarding the allegation that staff do not assist residents with incontinence needs, the investigation consisted of interviews with Administrator, Assistant Administrator, Staff #1 and Resident #1- Resident #6. Administrator and staff interviewed denied the allegation. They stated that residents who require assistance with their incontinence needs are assisted. Residents interviewed were unable to corroborate the allegation. 6 out of 6 residents interviewed, stated that they received assistance, or were aware that assistance was being provided to residents who require assistance.

Regarding the allegation(s) that residents do not get enough to eat and staff do not provide snacks to residents, the investigation consisted of interviews with Administrator, Assistant Administrator, Staff #1 and Resident #1- Resident #6. LPA also obtained copy of facility menu, and toured facility kitchen including food supply. Administrator and staff interviewed denied the allegation. They stated that residents are provided with a sufficient amount of food to eat at mealtimes, and they are provided with snacks. Residents interviewed were unable to corroborate the allegation. 6 out of 6 residents interviewed stated that residents are getting enough to eat and the staff do provide snacks to the residents.

Regarding the allegation that staff do not afford resident confidentiality, the investigation consisted of interviews with Administrator, Assistant Administrator, Staff #1 and Resident #1- Resident #6. Administrator
and staff interviewed denied the allegation. They stated that residents are afforded with confidentiality. Residents interviewed were unable to corroborate the allegation. 5 out of 6 residents stated that they are afforded with confidentiality.

Regarding the allegation that staff do not safeguard residents property, the investigation consisted of interviews with Administrator, Assistant Administrator, Staff #1 and Resident #1- Resident #6. Administrator and staff interviewed denied the allegation. They stated that residents property is safeguarded. Residents interviewed were unable to corroborate the allegation. 6 out of 6 residents stated that their property is safeguarded.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20220329161435

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: 04/06/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Based on LPA's observations and interviews, investigation revealed: 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.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Assistant Administrator, Rachel De Chavez.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3