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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 06/27/2026
Date Signed: 06/29/2026 05:31:36 AM

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
12/23/2025 and conducted by Evaluator Tihesha Smith
COMPLAINT CONTROL NUMBER: 31-AS-20251223142812
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: 90DATE:
06/27/2026
UNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Susan Park, AdministratorTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Staff failed to assist the resident in obtaining medical care
Staff failed to safeguard the residents’ confidential information
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tihesha Smith conducted an unannounced complaint visit this facility to investigate the above allegations. LPA Smith was greeted by staff and disclosed the purpose of the visit.

Staff failed to assist the resident in obtaining medical care
Staff failed to safeguard the residents’ confidential information

It was alleged that staff would not contact Resident #1’s (R1) preferred medical assistant and that staff disclosed R1’s health information to another staff member. On 09/30/25, LPA Smith interviewed two (2) staff from 9:40 a.m. to 9:55 a.m. and reviewed the personnel report and client register. Staff #1 (S1) reported that R1 complained of a persistent cough,feeling nervous and weak, experiencing altered perceptions, and referenced a pre-existing health condition.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2026
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 2
Control Number 31-AS-20251223142812
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: 06/27/2026
NARRATIVE
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(cont from 9099)

S1 confirmed R1’s vital signs were stable and no distress was observed. S1 stated R1’s primary care physician was contacted because R1 was not at their baseline, and the physician recommended transfer to urgent care, after which staff arranged transportation. S1 also stated the assistant administrator informed the administrator of R1’s condition and reason for transport and informed EMT personnel. R1 disagreed with staff sharing their information with EMT personnel conflicting but confirmed staff did provide transport to the hospital and issue has already been settled with staff. Interviews with ten (10) of (10) residents revealed that staff assist with medical needs when required. Seven residents reported no concerns regarding privacy breaches and two residents did not provide answer. Administrator confirmed that EMT personnel must obtain resident information such as reason for transport, allergies, and current condition before transport. Based on interviews obtain during the investigation, there is insufficient evidence to support the allegations. therefore, the above allegations are unsubstantiated at this time.

No hazards observed at time of visit

Exit interview conducted/ copy of report given

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tihesha Smith
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2