197608506-8-18-2022-28-AS-MVAO-CJ9TLE-20220914144925

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 08/18/2022
Date Signed: 08/18/2022 02:30:59 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
08/12/2022 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220812093156

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: 69	DATE:	08/18/2022
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Assistant Administrator, Rachel De Chavez		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff do not assist the resident with making phone calls as needed.
Resident not accorded dignity in personal relationships with staff.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted a visit in response to the above allegations. On today's visit, LPA met with Assistant Administrator Rachel De Chavez who assisted with the visit.

Regarding the allegation that staff do not assist resident #1 with making phone calls as needed, the investigation consisted of : Interviews with Assistant Administrator, Staff #1 and Resident #1- Resident #6 and review of Resident #1's file. Assistant Administrator and Staff #1 stated that resident(s) who receive phone calls at the facility are assisted when needed. Staff interviewed stated that if a call comes in for a resident, staff will page the resident, and will transfer the phone call to another phone for the resident. Resident(s) interviewed were unable to corroborate the allegation. Five out of Six resident(s) interviewed stated that staff do provide assistance to resident(s) with phone calls when needed.

Regarding the allegation that Resident #1 is not accorded dignity in personal relationships with staff, the investigation consisted of : Interviews with Assistant Administrator, Staff #1, and Resident #1 - Resident #6.

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: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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-20220812093156

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: 08/18/2022

NARRATIVE

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Assistant Administrator and Staff #1 denied the allegation and stated that residents are treated with dignity and respect. Resident(s) interviewed were unable to corroborate the allegation. Five out of Six residents stated that staff treat them with dignity and respect.

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: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

LIC9099 (FAS) - (06/04)

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