197608506-11-14-2024-31-AS-NMAN-DDD26F-20250128160704

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 11/14/2024
Date Signed: 11/14/2024 01:52:00 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
10/16/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20241016090824

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:	11/14/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Susan Park		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not provide adequate food service to residents in care.
Staff do not treat resident(s) with dignity and respect.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Abeye Duguma and Angelica Segovia conducted a subsequent complaint visit to the facility to investigate the above allegations. LPAs met with Executive Director, Susan Park, and explained the reason for the visit.

---Staff did not provide adequate food service to residents in care.

It was alleged that the facility fails to consider the diverse cultural backgrounds of its residents in meal preparation. To investigate the allegation, LPAs requested documents at around 11:00a.m., interviewed three (03) staff and nine (09) residents from around 11:00a.m. to 1:15p.m. A review of the facility’s weekly menus revealed that a variety of well-balanced, diverse and nutritious foods are served. During interviews with staff, all staff stated they provide a variety of well-balanced meals.

(CONT. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

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-20241016090824

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST	FACILITY NUMBER: 197608506
	VISIT DATE: 11/14/2024

NARRATIVE

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During interviews with residents two (02) out of nine (09) residents stated they feel facility does not provide a variety of diverse foods, all remaining residents stated meals are diverse and well-balanced.

Based on interviews and record review, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

---Staff do not treat resident(s) with dignity and respect.

It was alleged that staff lack proper "bedside manners" and yell at other residents. To investigate the allegation, LPAs interviewed three (03) staff and nine (09) residents from around 11:00a.m. to 1:15p.m. During interviews with staff, all staff stated they treat residents with dignity and respect. During interviews with residents one (01) out of nine (09) residents stated they feel staff do not treat them with dignity and respect. All other residents stated they feel staff treat them with respect and dignity.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards were noted during the visit.

Exit interview was conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

LIC9099 (FAS) - (06/04)

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