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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 03/22/2025
Date Signed: 03/22/2025 03:20:56 PM

Substantiated


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
10/15/2024 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20241015110335
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: DATE:
03/22/2025
UNANNOUNCEDTIME BEGAN:
02:19 PM
MET WITH:Susan ParkTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Staff are not preventing resident from engaging in inappropriate behavior(s) in the presence of other residents in care.
Staff are not preventing resident from harassing other residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Abeye Duguma conducted a subsequent complaint visit to the facility to further investigate the above allegations. LPA met with Executive Director, Susan Park, and explained the reason for the visit.

---Staff are not preventing resident from engaging in inappropriate behavior(s) in the presence of other residents in care.

It was alleged that Resident #2 (R2) exposes themselves by not wearing clothes from the waist down. To investigate the allegations, on 10/17/2024, LPA interviewed four (04) staff and nine (09) residents from around 11:00a.m. to 1:30p.m. On 03/22/2025, LPA reviewed the Department’s records. During interviews with staff, Staff #4 (S4) stated they witnessed R2 exposed in the hallway after exiting the communal shower.

(CONT. LIC9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2025
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-20241015110335
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: 03/22/2025
NARRATIVE
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All other staff stated that R2 does not exposes themselves from the waist down to other residents. During interviews with residents, Resident #1 (R1) stated that R2 inappropriately exposes themselves. All other residents stated that they have never witnessed R2 exposing themselves from the waist down. A review of the Department’s Incident Report logs revealed that R2 has multiple reported incidents of exposing themselves.

Based on interviews and record review, there is enough information to verify the allegation. Therefore, the allegation is SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):


--- Staff are not preventing resident from harassing other residents in care.

It was alleged that R2 calls people socialist, Marxist, communist and makes trouble for everyone. To investigate the allegations, LPAs interviewed four (04) staff and nine (09) residents from around 11:00a.m. to 1:30p.m. On 03/22/2025, LPA reviewed the Department’s records. During interviews with staff, all staff stated that R2 calls staff socialist and Marxist but does not make trouble for resident. During interviews with residents, R1 stated that R2 calls them socialist and Marxist and makes trouble. All other residents stated residents do not make trouble or call them socialist and Marxist. A review of the Department’s Incident Report logs revealed that R2 has multiple reported incidents of aggressive behavior towards residents and staff.

Based on the interviews and record review, there is enough information to verify the allegation. Therefore, the allegation is SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

No other health and safety hazards were noted during the visit.



Exit interview was conducted.
Executive Director, Susan Park, does not agree with the finding and declined to sign the report. A copy of the report and Appeal Rights were printed and issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Citations on this Visit Report are Under Appeal!

Control Number 31-AS-20241015110335
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
03/24/2025
Section Cited
CCR
87468.1(a)(1)(2)(3)
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87468.1 Personal Rights of Residents in All Facilities(a)Residents...shall have all of the following personal rights:(1)To be accorded dignity in their personal relationships with staff, residents, and other persons.(2)To be accorded safe, healthful and comfortable accommodations, furnishings and
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The Licensee/Administrator will review Title 22, Division 6 Chapter 8 Article 08
87468.1 Personal Rights of Residents in All Facilities and submit a written letter stating they have reveiwed and will adhere to the regulation by the POC due date
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 equipment. (3) To be free from punishment, humiliation, intimidation, abuse, or other actions….This requirement is not met as evidenced by; Based on record review and interviews, R2 exposed themselves and intimidated residents with acts of aggression on multiple occasions.
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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: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 03/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/22/2025
LIC9099 (FAS) - (06/04)
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