197608506-8-28-2023-31-AS-NMAN-CWKP2C-20231013105544

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 08/28/2023
Date Signed: 08/28/2023 05:01:22 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
08/18/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20230818153501

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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Staff is not allowing resident to select health care provider

staff denied resident’s home health agency access to the facility

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced 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 staff is not allowing resident to select home health care provider. To investigate this allegation on 8/28/2023, between 11:15am and 12:20pm, staff interviews were initiated. Interviews revealed that Resident #1 (R1) and R1's responsible party were informed that the facility can refer them to third party services which are available within the facility. The facility provided the names of three different home health agencies and asked R1 and R1's responsible party to compare among the differnet home health agencies and to pick one. Staff #1 (S1) stated that neither R1 or R1's responsible party had selected a home health provider from the ones offered or had done any research on them. Staff # 2 (S2) told LPA that in the past different home health agencies that were not reputable were coming into the facility and providing services to
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-20230818153501

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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residents. Moreover, in order to avoid problems and to keep the community safe, they usually refer residents to the home health agencies that they have worked with the past. S1 told LPA that the facility does not force any resident to use the home health agencies they provide referrals to. At 1:30pm, LPA spoke to R1's responsible party and they confirmed what staff had told LPA. Neither responsible party or R1 had looked into other home health agencies besides the one suggested by the M.D.

Between 1:50pm and 2:23pm, LPA reviewed facility records. Records revealed that per admission agreement attachment concerning personal rights it states that residents have a right to receive or reject medical care or health-related services. R1 can choose any home health agency of their liking and the facility can not force them to use the ones provided by third parties within the facility.

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

It was alleged that staff denied resident’s home health agency access to the facility. To investigate this allegation, LPA initiated staff interviews between 11:15am and 12:20pm. Interviews revealed that staff would not deny health-related services chosen by R1 or any other resident. S2 stated that no one was notified of a home health agency coming to the facility and not being allowed inside. At 1:30pm, LPA called R1's responsible party and they said they did not know if in fact the home health agency had even gone to the facility. They were told that they were going to go, but no one saw them.

Based on interviews, there is not sufficient information to support this allegation. Thus this allegation is deemed to be 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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