197608506-2-13-2023-28-AS-MVAO-CQKUDR-20230404152959

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 02/13/2023
Date Signed: 02/13/2023 11:13:52 AM

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
02/03/2023 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230203112018

FACILITY NAME:	GLEN PARK AT GLENDALE - MARIPOSA ST		FACILITY NUMBER:	197608506
ADMINISTRATOR:	SUSAN PARK		FACILITY TYPE:	740
ADDRESS:	1220 S MARIPOSA ST		TELEPHONE:	(818) 242-9000
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	120	CENSUS: 71	DATE:	02/13/2023
		UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Susan Park		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff are physically abusing residents in care.

INVESTIGATION FINDINGS:

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On 02/13/2023 Licensing Program Analyst (LPA) Troy Agard initiated a complaint investigation at the above facility to address the above allegation. LPA Agard met with Susan Park, Administrator and explained the purpose of this visit was to gather information and deliver findings for this complaint.

The investigation consisted of the following: LPA toured the physical plant. The facility is licensed to served 120 non - ambulatory residents and has a hospice waiver for 10 residents. The facility is a single-story building located in a residential area. LPA Agard requested a staff and resident roster which were both received at the time of the visit. LPA Agard conduct interviews and reviewed the requested records.

Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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-20230203112018

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: 02/13/2023

NARRATIVE

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Regarding the allegation: Staff are physically abusing residents in care. It’s being alleged that two staff are abusing residents while in care. The investigation revealed the following: LPA interviewed 4 out of 35 staff. 0 out of 4 confirmed the allegation. All staff interviewed unanimously denied the allegation. S1cites, S2 and S3 do not provide direct support services to residents in care and act in an administrative role, solely.

During interviews with residents, LPA Agard interviewed 7 out of 71 in total. 0 out of 7 confirmed the allegation. All residents interviewed unanimously denied the allegation. All residents interviewed state they have never been hit or witnessed any residents being physically abused. Many residents interviewed denied knowing S2 and S3. R6 states, “I think I know S2, but I know S3 and they are both good to me.”

Based on LPA’s observation, and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of the report was given.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

LIC9099 (FAS) - (06/04)

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