197608506-1-6-2023-28-AS-MVAO-CN6SBU-20230117124432

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 01/06/2023
Date Signed: 01/06/2023 03:04:34 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,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/29/2022 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 28-AS-20221229160324

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: 72	DATE:	01/06/2023
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Susan Park		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

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Staff do not answer resident's call button in a timely manner
Staff do not provide resident with housekeeping
Staff do not communicate with resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the facility to investigate the above allegations. LPA met with the administrator, Susan Park, and advised her of the complaint. Between 12:45pm to 1:30pm interviews were made with residents and staff. At approximately 1:30pm to 2:45 pm, a physical plant inspection and record review were conducted.

Staff do not answer resident's call button in a timely manner:
In regards to the allegation, it was reported that on or around 12/29/22, at approximately 8:30am, Resident 1 (R1) requested for some water, but response to her request for water wasn't made until 3pm. Interviews with staff and residents deny that staff do not answer calls in a timely manner. According to staff, that were on duty that day, water was given to R1, throughout that day, when requested by R1. No witnesses were identified to corroborate the allegation. Therefore, based on the information obtained, the allegation of staff not answering to the resident's call button in a timely manner is deemed Unsubstantaited at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Benita Yates	TELEPHONE: (323) 981-3962
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (323) 981-1782
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

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-20221229160324

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST	FACILITY NUMBER: 197608506
	VISIT DATE: 01/06/2023

NARRATIVE

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Staff do not provide resident with housekeeping:
In regards to the allegation, it was reported that on or around 12/29/2022, R1's meal tray wasn't picked up by staff. Interviews with staff and residents deny that staff do not provide residents with housekeeping. According to both administrator and staff, caregivers usually check up on residents throughout the day and if there is an empty meal tray, staff would collect the tray. Also, according to both administrator and staff, some clients would place their meal tray outside their door for staff to pick up. At no time was R1's tray left in their room. A review of R1's records indicate that R1 is ambulatory, able to follow instructions, and able to feed self. There were no witnesses to corroborate the allegation of staff not providing housekeeping. Therefore, the allegation is deemed Unsubstantiated at this time.

Staff do not communicate with resident:
In regards to the allegation, it was reported that R1 tried to speak with management and staff about their concerns of a visitor, running up and down the halls, and jiggling R1's door knob, however, management and staff will not communicate with R1 when R1 requests to address this with them. Interviews with staff and residents deny that staff do not communicate with the residents. Furthermore, there was no witnesses to, nor video footage in the hallways of a visitor running up and down the hallways of the facility. The administrator stated she has an open door policy, and is available to the residents throughout her shift to address any of their concerns, and she's never denied meeting with R1. Staff are also available to assist residents at their request and answer any of their questions. LPA reviewed and obtained facility logs and records, indicating that the administrator, and staff have met with R1 to address R1's concerns. Concerns were also addressed with R1's physician. Based on the information obtained, there was insufficient evidence to corroborate the allegation of staff not communicating with residents. Therefore, the allegation is deemed Unsubstantiated at this time.

SUPERVISOR'S NAME: Benita Yates	TELEPHONE: (323) 981-3962
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (323) 981-1782
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2023

LIC9099 (FAS) - (06/04)

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