197608506-8-28-2023-31-AS-NMAN-CW2USJ-20230926155022

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 08/28/2023
Date Signed: 08/28/2023 05:03:27 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.RO, 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
05/10/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20230510115726

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: 83	DATE:	08/28/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Susan Park, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Wrongful eviction.

Facility is accepting payments for resident no longer in care.

Facility did not adhere to resident's Admissions Agreement.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced subeqent complaint investigtion visit for the above noted allegations. LPA met with Administrator Susan Park. The purpose of the viist was explained.

It was reported that Resident #1 (R1) was wrongfully evicted from the facility. To investigate this allegation on 8/28/2023 between 11:15am and 12:20pm, staff interviews were iniaited. Interviews revealed that R1 was admitted to the hospital on 11/4/2022 due to numbness and swelling of the arms and legs. On 11/18/22, R1 was discharged to a Skilled Nursing Facility. On 11/28/2022, R1's responsible party was told that they could not remain at the facility due to requiring a higher level of care. On 11/29/2022, R1 told staff that they would not be returning to the community and that their case worker would help them find a new placement. Responsible party agreed to pick up R1's personal belongings on 12/01/2022.

Continue on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

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-20230510115726

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST	FACILITY NUMBER: 197608506
	VISIT DATE: 08/28/2023

NARRATIVE

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Between 1:50pm and 2:23pm, LPA reviewed facility records. Facility records confirmed what staff told LPA. R1 was assessed on 11/09/2022 and 11/17/2022 and it was determined that they were bedridden and that they required a higher level of care. At 2:00pm, LPA called R1's responsible party and they stated that R1 was not evicted but rather told that do to their change in condition they could not return to the community because they required a higher level of care.

Based on interviews and records review, there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.

It was alleged that facility is accepting payments for resident no longer in care. Between 11:15am and 12:20pm, staff interviews were conducted. Interviews revealed that as soon as it was determined that R1 would no longer be returning to the community, that the facility stopped billing them. R1 was on an assisted living waiver and their social worker was notified that they would no longer reside at the facility. At 4:14pm, LPA reviewed facility records. Records revealed that R1 was not billed but that Social Security continued to make payments. Facility paid back the money to SSA on 6/20/2023;

Based on interviews and records review there is not sufficient information to support this allegation. Thus this allegation is deemed to be UNSUBSTANTIATED at this time.

It was reported that facility did not adhere to resident's Admissions Agreement. Between 1:50pm and 2:23pm, LPA reviewed facility records. Moreover, per admission policy in the admission agreement, the facility does not accept or retain the following adults: 1. Persons who are bedridden... R1 was assessed on 11/09/2022 and 11/17/2022 and it was determined that they were bedridden and that they required a higher level of care. Indeed, the facility did not retain R1 because they were adhering to the admission agreement. Staff interviews also confirmed this information. Staff told LPA that R1 had a change in condition and based on hospital assessments, required a higher level of care.

Based on records review and interviews, there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 08/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/28/2023

LIC9099 (FAS) - (06/04)

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