197608506-5-7-2025-31-AS-NMAN-DGGSL4-20250508135744

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 02/25/2025
Date Signed: 05/07/2025 10:49:16 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
02/18/2025 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20250218151741

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: 88	DATE:	02/25/2025
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	SUSAN PARK- Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal items.
Staff are retaliating against resident for making a report against the facility.

INVESTIGATION FINDINGS:

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This is an amendment of the original report issued 02-25-2025. The report is being amended to clarify the details of the findings. Licensing Program Analyst (LPA) Leslie Ngo-Castaneda conducted an unannounced initial complaint visit to the facility and met with the Administrator (Susan Park- S1). Entrance interview conducted.

Allegation#1: Staff removed resident’s personal items.

It was alleged that Resident #1 (R1)'s belongings for their supplements and vitamins were taken by the facility staff. To investigate the allegation, at 9:38 AM, LPA conducted physical plant tour at (time). At (time) LPA requested copies of facility documents relevant to the investigation, including R1’s physician report, need and service plan and inventory logs for personal belongings. LPA interviewed residents and staff between 10 AM to 12 PM. Inspection of R1’s room revealed that R1 is keeping their vitamins and supplement on nightstand in between their bed and door. Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

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-20250218151741

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: 02/25/2025

NARRATIVE

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Staff interviews revealed that R1 was admitted at this facility on 8.31.2020. R1 purchases vitamins and supplements through Amazon without a prescription/ approval from Primary Care Physician (PCP)/ specialists. Packages delivered to the facility would be opened by R1 in-front of staff. In order to protect R1, facility takes away R1 belongings (vitamins and supplements) until obtaining a prescription/ approval from PCP/ specialists.

LPA interviewed R1 at 10:28AM and they verified the information provided by staff. LPA interviewed eight (8) out of eighty-eight (88) residents who are at the facility, and it was revealed unanimously that residents have all their belongings with them and that they are happy and safe living at the facility. A review of R1’s records records between 12 PM to 1:30 PM, revealed that R1 required staff assistance to manage their medication.

Based on inspection, observation, interviews and record reviews, it was concluded that there is no sufficient information to determine validity of the complaint. Therefore, the allegation is UNSUBSTANTIATED at this time.

Allegation #2: Staff are retaliating against resident for making a report against the facility.

It was alleged that resident #1 (R1) fears that facility staff is retaliating against them for filing reports.

To investigate this allegation, LPA spoke with the administrator and interviewed five (5) staff and they denied retaliating against residents for any reason. They treat all their residents with respect and dignity. LPA interviewed eight (8) out of eighty-eight (88) residents and they revealed unanimously that they were never were retaliated by staff and all of them are treated well. They are happy and have no concerns about staff.

Based on overall information obtained during investigation, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

An exit interview was conducted, no citations were issued for the above allegation(s), and a copy of this report was given to the executive director.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda
LICENSING EVALUATOR SIGNATURE:	DATE: 02/25/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025

LIC9099 (FAS) - (06/04)

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