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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 01/28/2025
Date Signed: 01/28/2025 02:47:18 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
01/21/2025 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250121152426
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: 88DATE:
01/28/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Bryanna Luke & Crystal LopezTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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1. Staff are not providing adeuqate food service to resident
2. Unqualified staff handling food
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a complaint visit to discuss the allegations mentioned above. LPA met with administrator assistant Bryanna Luke, who was informed the reason of the visit, who had to leave and requested Crystal Lopez, Office Manager to conclude the visit. The following information was obtained during the investigation:

Allegation #1: Staff are not providing adequate food service to residents. During the visit, from 10am to 230pm, LPA conducted a physical plant inspection and interviewed staff and residents. From interviews and documentation obtained during the visit, it was reported to LPA, that hair was found in a meal that was served to a resident. Staff confirmed the incident, and an in-service training was immediately conducted. This is a health and safety risk to residents in care. Therefore, based on interviews and documentation, the allegation is Substantiated, and the plan of correction (POC) will be cleared during the visit.

(CONT. on LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
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 3
Control Number 31-AS-20250121152426
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST
FACILITY NUMBER: 197608506
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/28/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/28/2025
Section Cited
CCR
87555(15)
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General Food Service Requirements. (15) All persons engaged in food preparation and service shall observe personal hygiene and food services sanitation practices which protect the food from contamination.
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Assistant Administrator Bryanna Luke provided food hygiene in-service training record to LPA. POC is cleared during the visit.
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Type B
02/04/2025
Section Cited
CCR
87411(d)(1)
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Personnel Requirements - General (d)All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned...(1) Principles of good nutrition
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Assistant Administrator Bryanna Luke provided food hygiene in-service training record to LPA. POC is cleared during the visit.
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good food preparation and storage, and menu planning. This requirement was not met, evidenced by: based on interviews, staff who are assigned to work in the kitchen, never received proper training when preparing food to residents. This is a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250121152426
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST
FACILITY NUMBER: 197608506
VISIT DATE: 01/28/2025
NARRATIVE
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Allegation #2: Unqualified staff handling food. During the visit, from 10am to 230pm, LPA conducted a physical plant inspection and interviewed staff and residents. From interviews conducted, it was reported to LPA, that several staff who perform caregiver and housekeeping duties assist in the kitchen, serving or preparing food to residents. Although their job description requires them to assist in the kitchen, it was reported to LPA, those staff were not properly trained in handling or preparing food. This poses a potential health and safety risk to residents in care. Therefore, the allegation is Substantiated at this time. Plan of correction (POC) will be cleared during the visit.

Citations issued, appeal rights, exit interview, and copy of report provided.

(SEE LIC9099D - citations)
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3