197608506-7-11-2024-31-AS-NGID-D77VXY-20240715165016

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 07/10/2024
Date Signed: 07/11/2024 08:30:36 AM

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
05/29/2024 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20240529144810

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:	07/10/2024
		UNANNOUNCED	TIME BEGAN:	09:32 AM
MET WITH:	Susan Park- Executive Director		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff do not provide adequate food service
Staff do not ensure the residents have hygiene products while in care

INVESTIGATION FINDINGS:

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On 7.10.2024 Licensing Program Analyst (LPA) Leslie Ngo-Castaneda arrived at the facility to conduct an unannounced subsequent visit to deliver the determination on the above allegations. LPA was greeted by Susan Park who is the Executive Director (ED) of the facility.

An entrance interview was conducted.

At 10:00 AM LPA conducted a physical plant tour to ensure the health and safety of the residents in care.

To investigate the allegations above, LPA conducted an initial visit on 6.03.2024. LPA toured the facility and requested and reviewed the staff roster, resident roster, admissions agreement, appraisals, and incident reports. LPA interviewed staff and residents. LPA reviewed records on 6.07.2024.

Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

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-20240529144810

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: 07/10/2024

NARRATIVE

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Interviews with (10) residents out of eighty-nine (89) residents and five (5) out of forty-five (45) staff that the above statement is untrue, and all residents expressed no concern regarding this allegation.

Allegation: Staff do not provide adequate food service.

More specifically the complainants concern was that the facility does not provide adequate food service, which result in an illness of a resident in care. On May 27, 2024, one resident in care suffered an upset stomach after having breakfast and believes it came from old, spoiled food. On June 3, 2024, LPA Ngo-Casteneda conducted a facility tour which included a food service tour and inspection. LPA observed sufficient supply of 2-day perishable foods and one week of non-perishable foods. LPA inspected food service area which include food storage and prep areas, refrigerator, and freezer. LPA observed areas to be clean. Foods were observed to be properly stored at temperatures within regulations. Foods were observed to be property wrapped and stored to protect foods from spoilage and cross-contamination. Interviews with facility staff revealed that when food supplies arrived from Sysco food is immediately stored in the freezer and walk-in refrigerator. Based on the information received this allegation is Unsubstantiated at this time. LPA could not determine that the resident in care became ill from the food. Proper food handling appears to be followed. No other residents reported illness related to food on or about June 3, 2024.

Allegation: Staff do not ensure the residents have hygiene products while in care.

It was alleged that R1 was not supplied enough hygiene products from the facility. During the interview, it was revealed that R1 would not ask staff for more supplies when they run out of products. R1 is expecting to be given and handed the number of supplies as requested without using the supplies they have first. ED advised LPA that the following number of products are given to residences: two (2) daily towels, toilet paper one (1) per week, One (1) paper towel monthly, one (1) shampoo per month, one (1) bodywash (or soap) per month, and one (1) toothpaste per month. Interview with residents six (6) residents out of ten (10) revealed that there is no issues with receiving extra supplies when asked. If the facility runs out of supplies, the facility has a driver who can run errands for them to purchase and supply the residents with what the facility needs. During the facility tour, LPA also observed a supply of hygiene products.

Based on the information received this allegation is Unsubstantiated at this time.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 07/10/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2024

LIC9099 (FAS) - (06/04)

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