197608506-5-12-2023-31-AS-NGID-CRYMXL-20230519100007

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 05/12/2023
Date Signed: 05/12/2023 01:35:55 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2023 and conducted by Evaluator Shira Stamps

COMPLAINT CONTROL NUMBER: 31-AS-20230504115722

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: 81	DATE:	05/12/2023
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Susan Park, Administrator		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

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Staff member inappropriately accessed resident's personal property.

INVESTIGATION FINDINGS:

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On 5/12/23 at 11:30am, Licensing Program Analyst (LPA) Shira Stamps arrived at the facility for an initial 10-day complaint visit. LPA was greeted by the Administrator, and entrance interview was conducted.

At 11:30 am, LPA collected; including but not limited to the following documents: LIC 500 and staff schedule, the Census, physician report, appraisal needs and service, etc. A physical plant tour was conducted with the Adminstrator at 12:00pm. LPA conducted interviews from 11:40-12:30pm with staff and residents.

Allegation: Staff member inappropriately accessed resident's personal property.
It was alleged that a staff member takes resident one’s (R1) phone to makes personal calls or sends text messages on R1’s phone. LPA interviewed residents, and it was indicated that four (4) out of eight (8) residents have a personal cell phone. CONTINUED...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Shira Stamps	TELEPHONE: (818) 669-6375
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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 31-AS-20230504115722

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST	FACILITY NUMBER: 197608506
	VISIT DATE: 05/12/2023

NARRATIVE

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The four (4) residents indicated that staff has never used their cell phone. Interviews with four (4) out of four (4) staff members indicated that staff members do not use resident cell phones. Based on interviews it was found that R1’s phone was accessed and used by another resident in the facility and not a staff member. Therefore, based on interviews it was found that staff members have never accessed R1’s phone nor any other residents phones. The allegation, “Staff member inappropriately accessed resident's personal property,” is deemed unsubstantiated.

Exit interview conducted. Copy of report delivered to Administrator.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Shira Stamps	TELEPHONE: (818) 669-6375
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC9099 (FAS) - (06/04)

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