197608506-6-1-2026-31-AS-NGID-DVMT95-20260703143121

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 06/01/2026
Date Signed: 06/01/2026 12:45:47 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
09/30/2025 and conducted by Evaluator Huma Rahimi

COMPLAINT CONTROL NUMBER: 31-AS-20250930090108

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: 92	DATE:	06/01/2026
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Susan Park, Administrator		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff did not provide adequate supervision resulting in resident sexually touching another resident.

INVESTIGATION FINDINGS:

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At 10:00 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent visit to this facility to deliver the final report. LPA met with the Administrator Susan Park and explained the reason for the visit.
On 09/30/2025, the Woodland Hills South Adult and Senior Care Regional Office received a complaint regarding the allegation, “Staff did not provide adequate supervision resulting in resident sexually touching another resident.” The complaint was referred to Community Care Licensing Division’s Investigations Branch (IB).
On 09/30/2025, LPA Rahimi conducted an initial complaint visit. LPA obtained copies resident and staff roster. LPA conducted a physical plant tour and obtained other pertinent information, including but not limited to Physician Report, Admission Agreement, Appraisal Needs and Service Plan, Staff Training, etc., which is relevant to the investigation.

Continue on LIC 9099C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

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-20250930090108

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: 06/01/2026

NARRATIVE

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Allegation: Staff did not provide adequate supervision resulting in resident sexually touching another resident.

As part of the investigation, the Department requested and reviewed a police report from the Glendale Police Department on 10/06/2025, conducted interviews with the Administrator and Resident #1 (R1) on 10/10/2025. The department reviewed surveillance footage on 10/10/2025, and interviewed a caregiver on 10/15/2025.

The investigation revealed that R1 has resided at the facility since March 2004 and Resident #2 (R2) has resided at the facility since October 2024. On 09/24/2025, law enforcement responded to the facility following a report that R2 engaged in inappropriate physical contact with R1 in the dining room.

On 10/10/2025, the Department interviewed R1. Due to diminished cognitive capacity associated with dementia, R1 was unable to provide a reliable statement regarding the incident.

The Department reviewed surveillance footage, which showed R1 seated in the dining room when R2 approached and made physical contact with R1's chest area over clothing. The footage showed R2 leaving the area immediately after the contact. Staff intervention occurred only after the contact had already taken place, at which time a staff member approached R1, adjusted R1's clothing, and checked on R1's well-being.

On 10/15/2025, the Department interviewed a caregiver who witnessed the incident. The caregiver reported observing R2 approach R1 and engage in inappropriate physical contact before leaving the dining room. The caregiver stated that they immediately checked on R1 and reported the incident to the Administrator.

During the investigation, the Administrator reported that R2 had a history of inappropriate behaviors and boundary violations involving other residents. The Administrator further reported that approximately one month prior to the incident, R2 was observed entering R1's room without authorization. Although that incident could not be conclusively substantiated due to insufficient evidence, it raised concerns regarding R2's interactions with other residents. The Department's review also identified repeated incidents and concerns involving inappropriate behavior by R2 toward both residents and staff prior to the 09/24/2025 incident.

Continue on LIC 9099C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250930090108

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: 06/01/2026

NARRATIVE

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The evidence established that facility administration was aware of R2's pattern of inappropriate and escalating behaviors before the incident involving R1. Despite this knowledge, the supervision and protective measures in place were not sufficient to prevent R2 from accessing and engaging in inappropriate physical contact with another resident. The incident occurred in a common area of the facility and was not prevented despite R2's known behavioral history and prior boundary violations.

Based on interviews conducted, records reviewed, surveillance footage reviewed, and information obtained during the investigation, the Department determined that the incident occurred as reported. The preponderance of evidence established that the facility was aware of R2's history of inappropriate conduct and escalating behavioral concerns and failed to provide supervision sufficient to protect residents from a foreseeable risk of harm. As a result, R2 was able to engage in inappropriate physical contact with R1 before staff intervention occurred.

Therefore, the allegation that staff did not provide adequate supervision resulting in a resident sexually touching another resident is Substantiated.

Deficiencies issued and appeal rights explained.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20250930090108

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: 06/01/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 06/02/2026 Section Cited CCR 87468.1(a)(1-3)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities for the … (1) To be accorded ... (2) To be accorded safe, ... (3) To be free from punishment, humiliation, intimidation, abuse…This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Administrator agreed to provide a training to all staff regarding this section. Administrator will submit the training sheets to LPA by the POC due date.
	8 9 10 11 12 13 14	Based on surveillance footage reviewed by the Department and interviews conducted, Resident #2 (R2) approached Resident #1 (R1) in the dining room and made inappropriate physical contact with R1.	8 9 10 11 12 13 14	Information obtained during the investigation revealed that the licensee was aware of R2's prior inappropriate behaviors and boundary violations but failed to provide supervision sufficient to prevent the incident. This poses an immediate health, safety, and personal rights risk to residents in care.
Type A 06/01/2026 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	Personnel Requirements-(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet residents needs...This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Administrator shall submit a written plan describing how the facility will ensure adequate supervision of residents with known behavioral concerns. Administrator shall provide training to all staff on resident supervision and abuse prevention & submit the training proof to LPA by POC date.
	8 9 10 11 12 13 14	Based on interviews, records, and surveillance footage reviewed, the Department determined that R2 engaged in inappropriate physical contact with R1 before staff intervened.	8 9 10 11 12 13 14	Although the facility was aware of R2's history of inappropriate behaviors and boundary violations, adequate supervision was not provided to prevent the incident, resulting in a foreseeable risk of harm to residents. This poses an immediate health, safety, and personal

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: Nichelle Gillyard
LICENSING EVALUATOR NAME: Huma Rahimi
LICENSING EVALUATOR SIGNATURE:	DATE: 06/01/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/01/2026

LIC9099 (FAS) - (06/04)

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