197608506-12-13-2022-28-AS-TVAO-CNNVYD-20230202155059

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 12/13/2022
Date Signed: 12/13/2022 12:50:47 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
12/07/2022 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221207084028

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: 76	DATE:	12/13/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Susan Park, Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not ensuring residents are not exposed to hazardous smells.
Staff are not ensuring the facility ventilation system is not in disrepair.
Staff are not ensuring the floors are free of dirt.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegations listed above. LPA arrived unannounced and met with Administrator, Susan Park. The purpose of the visit was explained.

The investigation consisted of the following:
LPA Chan toured the facility and obtained copies of the staff roster, resident roster, and housekeeping assignment sheet. Interviews were held with the Administrator, 5 Staff, and 7 Residents.

The investigation revealed the following:
For allegation - Staff are not ensuring residents are not exposed to hazardous smells. It is alleged that the smoke and/or smells from the kitchen is polluting the facility and making residents sick. Administrator Park denied any hazardous smells that are causing any residents to be sick. She stated that this concern was brought to her attention and it has been addressed.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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 2

Control Number 28-AS-20221207084028

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST	FACILITY NUMBER: 197608506
	VISIT DATE: 12/13/2022

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

She stated the Department of Public Health (DPH) inspector came out last week to check all the ventilation and did not find any concerns. The Administrator had accommodated the resident by opening the dining room windows and doors to circulate the air. She also stated that the facility fan is consistently running as recommended by DPH. LPA interviewed 5 Staff and none reported any lingering smells or smoke that might cause residents to be sick. 6 out of the 7 residents interviewed do not feel they are exposed to hazardous smells at the facility. LPA toured the dining room and living room during the visit today and did not encounter any hazardous smells.

For allegation - Staff are not ensuring the facility ventilation system is not in disrepair. It is alleged that the kitchen vents are not operating properly to remove the smoke and smell out of the facility. Administrator stated that the ventilation system in the kitchen is working properly. LPA toured the kitchen and observed a large kitchen range hood vent that was in operation while the chef was preparing lunch. Interview was conducted with the chef who stated the kitchen ventilation system is on 24 hours a day and is working properly to remove any smoke or smells when they cook. LPA interviewed the office manager from the Maximum Exhaust Cleaning company who confirmed that services for the range hood is done every 6 months at this facility and the last inspection was on 8/24/222. The job report noted that everything is performing properly.

For allegation - Staff are not ensuring the floors are free of dirt. The administrator stated the facility is being cleaned at least once a day. There are about 3-4 housekeepers who mop or vacuum the floors/carpets in the resident rooms once a week and more often if needed. They also clean the common areas and hallways daily. If they see the floors need extra cleaning, they will mop the floor again. During the visit today, LPA observed housekeepers vacuuming the rooms and did not see any pile or trail of dirt in the hallways. The staff interviewed indicated they try their best to keep the facility as clean as possible. 6 out of the 7 residents interviewed stated that the staff clean their rooms daily and mop/vacuum at least once or twice a week. They feel the staff do a good job in keeping their rooms and facility clean.

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 held. A copy of this report along with the appeal rights were provided to the Administrator.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2