197608506-5-22-2023-31-AS-TAGD-CUJUX2-20230809155737

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 05/22/2023
Date Signed: 05/22/2023 12:27:29 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
05/15/2023 and conducted by Evaluator Tuesday Cabiness

COMPLAINT CONTROL NUMBER: 31-AS-20230515111101

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:	05/22/2023
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Susan Park		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Facility does not have hot water

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator Susan Park and formed her the reason of the visit.

From 945am to 1130am LPA interviewed the Administrator and conducted a physical inspection of random resident's and measaured hot water, which ranged from temperatures of 105.0, 114.8, 107.6, 109.4, and 119.5, which was in compliance with Licensing regulations. Although, the Administrator confirmed the hot water was out, a plumbing technician and the gas company came the same day, and attempted to fix the boiler. The boiler needed a part, which was ordered and the boiler was fixed two days later. The Administator, submitted an incident report, and all residents were notified that the hot water was not operable, but would be fixed. The facility made hot water arrangements for residents who wanted to shower. Hot was provided to them in there rooms, from the kitchen, by boiling water on the stove. And the facility made arrangements with there other facility, across the street, for residents to shower. Therefore, based on physical plant inspection, and documentation received, the allegation is Unsubstantiated at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 05/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2023

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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