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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 11/13/2024
Date Signed: 11/13/2024 01:59:33 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
05/23/2023 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20230523084151
FACILITY NAME:GLEN PARK AT GLENDALE - MARIPOSA STFACILITY NUMBER:
197608506
ADMINISTRATOR:SUSAN PARKFACILITY TYPE:
740
ADDRESS:1220 S MARIPOSA STTELEPHONE:
(818) 242-9000
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:120CENSUS: 94DATE:
11/13/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Susan ParkTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility staff are not allowing residents to leave the building.
Facility staff are tying the doors at night trapping residents in the facility.
Facility staff steal residents' money and belongings.
Facility staff allow residents with prohibited health conditions.
Facility staff deny residents food.
Facility staff are emotionally abusing residents.
Facility staff threaten residents.
INVESTIGATION FINDINGS:
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On 11/13/24 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced subsequent visit to continue the investigation on the above allegations and deliver determinations. LPA was greeted by the Executive Director (ED), Susan Park. LPA explained the reason for the visit. Entrance interview conducted.

To investigate the allegations, an initial visit was conducted on 05/30/23, by LPAs Michael Cava and Mariana Agban. During the initial visit LPAs interviewed the ED, Susan Park and conducted a record review. On 10/10/24 LPA Rios interviewed ten (10) randomly selected residents, the ED and one (1) staff. Residents interviewed were living in the facility during the initial visit on 05/30/23. LPA reviewed five (5) resident records and obtained copies of pertinent documents. On 11/12/24, LPA Rios conducted four (4) staff interviews. LPA also reviewed three (3) resident records. LPA reviewed 9 residents' medication and medication records for correctness. To assist with the investigation LPA Rios referenced the investigation conducted by LPAs Esther Cortez, Ashley Smith, and Kelly Dulek at Glen Park at Ojai, Complaint Control 29-AS-20230406155619. (Cont. to LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
05/23/2023 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20230523084151

FACILITY NAME:GLEN PARK AT GLENDALE - MARIPOSA STFACILITY NUMBER:
197608506
ADMINISTRATOR:SUSAN PARKFACILITY TYPE:
740
ADDRESS:1220 S MARIPOSA STTELEPHONE:
(818) 242-9000
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:120CENSUS: 94DATE:
11/13/2024
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Susan ParkTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are under the influence while at the facility.
INVESTIGATION FINDINGS:
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5
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7
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10
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13
On 11/13/24 Licensing Program Analyst (LPA) Evelin Rios arrived at the facility to conduct an unannounced subsequent visit to continue the investigation on the above allegation and deliver a determination. LPA was greeted by the Executive Director (ED), Susan Park. LPA explained the reason for the visit. Entrance interview conducted.

Allegation: Facility staff are under the influence while at the facility. Regarding the allegation. it was reported staff#2(S2) is under the influence while performing their job. LPA Rios review of Personnel Report (LIC500) and Guardian Background Check System, revealed no one with S2’s name was found associated or listed as a staff member to this facility. S2 is associated to a different facility. On 11/13/24 ED informed LPA, S2 has not spent any time in the facility assisting residents or would have any reason to be handling their medicatiion. Based on the information obtained the allegation has been unfounded meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
No deficiencies cited. Exit interview conducted. Copy of report provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20230523084151
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST
FACILITY NUMBER: 197608506
VISIT DATE: 11/13/2024
NARRATIVE
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Allegation: Facility staff are not allowing residents to leave the building.
Allegation: Facility staff are tying the doors at night trapping residents in the facility.
Based on the information gathered, LPA addressed the above allegations collectively, which claim that residents are prevented from leaving the building by staff obstructing the facility doors. Interviews conducted by LPA Rios on 10/15/24 and 11/12/24 revealed that eight (8) residents and five (5) staff members who were present during the initial visit denied witnessing any instances of the doors being tied up or obstructed by furniture or other means, day or night. According to resident interviews, those who do not require assistance when leaving the facility can do so by signing out. According to residents that are not able to leave the facility unassisted based on their Physician’s Report (LIC602), theydid not express concerns about being able to leave the facility. Staff interviews indicated that residents who need assistance, as per their LIC602, typically leave with the Activities Coordinator for planned outings, with family members, or are redirected to stay while waiting for a planned outing. The Executive Director denies that residents are trapped in the building. Furthermore, according to the ED cameras placed in common areas that have been reviewed have not alerted to such instances. LPAs' tours of the facility on 05/30/23, 10/15/24, and 11/12/24 did not observe any health or safety concerns. Based on interviews, record reviews, and observations, the allegation is deemed Unsubstantiated at this time.

Allegation: Facility staff steal residents' money and belongings. In regards to the allegation, it was alleged resident’s money, medication, and belongings are being stolen. On 10/15/24, LPA's interview with six (6) out of eight (8) residents that were interviewed denied having money or items stolen or witnessing staff stealing from residents. Two (2) out of eight (8) residents interviewed reported items being stolen or going missing, eight (8) to thirteen (13) years ago. Both stated that the issue was addressed and has not reoccurred. LPA's interviews with five (5) staff and the ED between 10/15/24 and 11/12/24, deny the allegation. On 10/15/24 the ED informed LPA, residents that receive P&I sign a log when a check is provided to them and the facility keeps petty cash and receipts when purchases are made. ED also informed LPA residents' personal belongings are recorded and updated annually on a Personal Property Inventory form by residents and family members. Staff and the ED noted, resident diagnosed with Dementia occasionally claim money or items are missing, but these are typically found to be misplaced or already spent by the resident. On 11/12/24, LPA with the assistance of the LVN conducted a medication and medication record review for nine (9) residents of which four (4) are taking a PRN narcotic medication.

(Continue to LIC9099-C) Page 2 of 4

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20230523084151
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST
FACILITY NUMBER: 197608506
VISIT DATE: 11/13/2024
NARRATIVE
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Centrally Stored Medication and Destruction records matched medication in locked cart. LPA observed narcotic pills popped out of bubble wrap packs were documented on the electronic medication administration record (MAR). LPA observed narcotic PRN medication from 2023 that had not yet expired, was still intact in bubble wrap. Based on interviews, observation and record review the allegation is deemed Unsubstantiated at this time.

Allegation: Facility staff allow residents with prohibited health conditions. Regarding the allegation, it was alleged the facility retains residents with prohibited health condition such as severe pressure injuries. Interview with the ED on 10/15/24 and 11/12/24 revealed residents who have prohibited health conditions are receiving Hospice services for such conditions and have care plans on file. ED also noted training is conducted by a certified professional and the facility documents such training when they are done for residents with prohibited and restricted health conditions. There is currently one (1) resident, Resident #1 (R1) with a pressure injury. LPA's review of R1's file on 10/15/24, revealed R1 is receiving Hospice services and wound care by Hospice for a stage 3 pressure wound. The prohibited health condition is allowable as R1 has been diagnosed as terminally ill and is currently receiving hospice care. Record review confirmed a wound care specialist is seeing R1 and providing proper and adequate care for the wound. Review of eight (8) other resident records revealed resident #2 (R2) has a restricted but allowable health condition and is also receiving services from a Hospice agency. Interviews with eight (8) residents revealed no issues with pressure injuries. Based on record review and interviews, the allegation is deemed Unsubstantiated at this time.

Allegation: Facility staff deny residents food. Regarding the allegation, it was alleged residents are being denied food. Interviews conducted on 10/15/24 with eight (8) residents revealed that the facility provides meals and snacks regularly, and none of the residents reported being denied food by the staff. One of the eight residents mentioned that the facility had stopped serving oranges and apples, but LPA and resident noted that other fruit options were available. Resident interviews also indicated that they had not observed any staff members denying food to other residents. Additional interviews with five (5) staff members and the Executive Director (ED) on 10/15/24 and 11/12/24 further confirmed that staff have never denied food to the residents. According to two staff members, residents who refuse a meal are offered a substitute. One staff member mentioned that the facility provides special meal and snack requests made by residents. Based on interviews, there is insufficient evidence to support the claim, facility staff deny residents food. Therefore, this allegation is deemed Unsubstantiated at this time.

(Continue to LIC9099-C) Page 3 of 4

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20230523084151
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST
FACILITY NUMBER: 197608506
VISIT DATE: 11/13/2024
NARRATIVE
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Allegation: Facility staff are emotionally abusing residents.
Allegation: Facility staff threaten residents.
Based on the information gathered, LPA addressed the above allegations collectively, which claimed that residents are being bullied and threatened, causing emotional damage. LPA Rios interviewed eight (8) residents living in the facility during the initial visit. They revealed having no knowledge of bullying or emotional damage caused by staff. One of the eight residents stated they had observed preferential treatment given to certain residents during lunch and expressed that Staff #3 (S3) lacked professionalism. Resident interviews also revealed that there are staff members whom residents are very happy with and that they are satisfied with the assistance provided. Interviews with five staff members on 10/15/24 and 11/12/24 denied the allegations. Two staff members stated they had witnessed residents being confrontational with other residents but never witnessed staff being confrontational with residents. LPAs' tours of the facility on 05/30/23, 10/15/24, and 11/12/24 did not reveal any health or safety concerns. Based on interviews and observations, there is insufficient evidence to support the claims that facility staff are emotionally abusing or threatening residents. Therefore, these allegations are deemed Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted. A copy of the report was issued.

Page 4 of 4

SUPERVISOR'S NAME: Eva MillerTELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Evelin RiosTELEPHONE: 424-299-6104
LICENSING EVALUATOR SIGNATURE:

DATE: 11/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/13/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5