197608506-9-26-2024-31-AS-NMAN-DG8SM9-20250430135931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 09/26/2024
Date Signed: 09/26/2024 03:00:46 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
09/17/2024 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20240917152632

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: 94	DATE:	09/26/2024
		UNANNOUNCED	TIME BEGAN:	11:35 AM
MET WITH:	Susan Park, Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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The Administrator became resident's payee for SSI payments.

Licensee did not ensure to return resident's SSI checks upon relocation

INVESTIGATION FINDINGS:

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LIcensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegations. LPA met with Executive Director (E.D.) Susan Park and explained the reason for the visit.

It was reported that the Administrator became resident's payee for SSI payments. To investigate this allegation on on 09/26/2024, between 12:00pm and 12:45pm, staff interviews were initiated. Interviews revealed that Administrator was never Resident #1 (R1)'s payee for SSI payments or anything other payments. SSI sent the money directly to the facility. Between 1:00pm and 1:30pm, LPA reviewed facility records. Records confirmed what staff had told LPA.

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

Continue on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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-20240917152632

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: 09/26/2024

NARRATIVE

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It was alleged that Licensee did not ensure to return resident's SSI checks upon relocation. To investigate this allegation on 07/22/2024, between 1:00pm and 2:00pm, staff interviews were initiated. Interviews revealed that the facility did contact Social Security and had notified them that R1 had moved out of the community and that their money needed to be paid to the other facility. Between 1:00pm and 1:30pm, LPA reviewed facility records. Records revealed that facility returned $7,171,.79 back to Social Security.

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

No health and safety issues noted at the time of this visit.

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

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

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