<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 08/12/2025
Date Signed: 08/12/2025 01:52:50 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.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
08/07/2025 and conducted by Evaluator Huma Rahimi
COMPLAINT CONTROL NUMBER: 31-AS-20250807163639
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:
08/12/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Susan Park, AdminstratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
 Staff did not give resident privacy.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
At 10:00 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced initial complaint visit to this facility to investigate the above allegation. LPA was greeted by the front desk receptionist. LPA met with the Administrator, Susan Park. LPA explained the reason for the visit. An entrance interview was conducted.

During course of the investigation, interviews and record review were made. At 10:10 AM, LPA requested resident and staff roster. At 10:15 AM, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician Report, Appraisal Needs and Services Plan, Resident Privacy Policy, etc., relevant to the investigation. At approximately 10:20 AM, LPA conducted a physical plant tour. Between 10:30 AM – 1:00 PM, LPA conducted an interview with the Administrator, Administrator Assistant (AA), a MedTech, a staff, and eleven (11) out of fifteen (15) residents who were avaliable to communicate.

Continue on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
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-20250807163639
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: 08/12/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Staff did not give resident privacy.
It was alleged that the Administrator entered residents' room unannounced. To investigate this allegation LPA conducted a physical plant tour with the Administrator and AA. During the physical plant tour LPA observed that although the Administrator knocks on the door before entering, Administrator does not wait for the permission to enter a resident room which violates their privacy and personal rights. Additionally, interview with eleven (11) out of fifteen (15) residents confirmed that Administrator does not wait for residents approval before entering their rooms. Therefore, based on LPA's observation and interviews this allegation is deemed Substantiated.

Deficiency cited and appeal rights explained.
Exit interview conducted copy of this report signed and delivered.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20250807163639
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/19/2025
Section Cited
CCR
87468.1(a)(1)
1
2
3
4
5
6
7
87468.1 Personal Rights of Residents in all Facilities (a) Residents in all residential care facilities for the elderly shall...(1) To be accorded dignity in their personal relationships with staff, ....
This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The Administrator agreed to conduct an in-service training to all staff including the Administrator on the cited section and submit a proof to LPA by the POC due date.
8
9
10
11
12
13
14
Based on LPA's observation and interviews, the licensee did not comply with the section cited above by entering residents rooms without their permission, which posed a potential Health, Safety, or Personal Rights risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3