197802560-8-11-2023-28-AS-RORN-CV8QF6-20230831120725

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197802560
Report Date: 08/11/2023
Date Signed: 08/11/2023 11:48:19 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/17/2023 and conducted by Evaluator Christine Wong

COMPLAINT CONTROL NUMBER: 28-AS-20230417131724

FACILITY NAME:	GLEN PARK AT MONROVIA		FACILITY NUMBER:	197802560
ADMINISTRATOR:	ACHARYA, NIRJARA		FACILITY TYPE:	740
ADDRESS:	110 N MOUNTAIN AVE		TELEPHONE:	(626) 357-6818
CITY:	MONROVIA	STATE: CA	ZIP CODE:	91016
CAPACITY:	49	CENSUS: 39	DATE:	08/11/2023
		UNANNOUNCED	TIME BEGAN:	09:14 AM
MET WITH:	Pamela Ogott		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff is abusing residents
Staff sexually abusing residents.
Facility financially abusing residents.
Staff are stealing residents medication.
Facility is retaining residents with prohibited health conditions.
Facility illegally evicting residents.
Residents are locked in facility.
Facility staff threatened residents.
Facility not safeguarding residents personal belongings.
Residents are denied food.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

***This report will supersede the original complaint report created on 05/02/2023. The purpose of this report is to add additional information from the original complaint report. However, the findings of the allegations will not change. ***

Licensing Program Analysts (LPAs) Christine Wong and Sanjay Vaid conducted a “Subsequent” visit to ascertain additional information regarding the above-mentioned allegation(s) and for the purpose of rendering the findings. LPA met with Assistant Administrator Martha Rosas who allowed entry into the facility and was later met by Administrator Pamela Ogott who assisted with the visit.

The investigation consisted of the following: On 5/2/2023, LPA interviewed four residents (R1-R4), six staff (S1-S6) and administrator and obtained copy of documents for residents and staff training (Medication Managment and Resident's right) and reviewed residents' medication. On today's date, LPA interviewed additional 4 residents (R5-R8) for additional information and reviewed residents' P&I record. (See LIC 9099C for continatuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

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 4

Control Number 28-AS-20230417131724

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT MONROVIA	FACILITY NUMBER: 197802560
	VISIT DATE: 08/11/2023

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

The investigation revealed of the following: Allegation#1 "Facility is abusing residents" LPA interviewed eight residents and eight out of eight residents denied the allegation and stated that staff are good and they never witnessed or heard any staff abused residents. LPA interviewed staff and all denied the allegation. They reported they never heard or witnessed any staff abused the residents. LPA also interviewed the Chief Operating Officer (COO) and denied the allegation and stated the facility has no tolerance for abusing residents in the facility.

Allegation#2 "Staff sexually abusing residents." LPA interviewed eight residents and eight out of eight residents denied the allegation and reported they never witnessed or heard any staff sexually abused residents. LPA interviewed staff and all denied the allegation. Administrator stated that they would never tolerate any staff abused residents sexually or physically. LPA also interviewed the alleged employee and denied the allegation and reported its never happened. Facility staff reported the alleged employee does not go to the facility regularly because the employee works as a Quality Assurance Manager. The employee usually comes to the facility to ensure the facility is operating well per regulation.

Allegation#3 "Facility financially abusing residents." LPA interviewed eight residents and eight out of eight residents denied the allegation and stated the facility never financial abused them. The facility did handle their money but they never took away their money or financially abused them. LPA interviewed staff and denied the allegation and stated that its never happened. Some staff reported they had been worked in the facility for over 20-30 years and they never heard anything about facility financially abused residents. LPA interviewed the COO and denied the allegation and reported its a false allegation and never handled residents' money directly. The facility has a cooperate office /accounting department to handle all residents' money. LPA also reviewed five (5) residents P&I record and all seemed accurate.

Allegation#4 "Staff are stealing residents medication." LPA interviewed eight residents and eight out eight residents denied the allegation and reported no medication was missing for them and they did take daily medication. LPA interviewed staff and staff reported only certain people have access to the medication room and the medication room is always locked. Administrator reported all the Med-Tech in the facility are trained. Nothing was reported the medication was missing, only residents was refused to take the medication. LPA also reviewed R1-R4 medication, they all seemed updated and accurate.

(See LIC9099C for continuation)

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 28-AS-20230417131724

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT MONROVIA	FACILITY NUMBER: 197802560
	VISIT DATE: 08/11/2023

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

Allegation#5 "Facility is retaining residents with prohibited health conditions." In regard to the allegation, the administrator stated that they do not have any resident with prohibited health condition. They would never admit any residents with prohibited health condition. It's because they are not a medical facility. If resident has any prohibited health condition, the facility would send the residents immediately to a higher level of care or hospital for reassessment. LPA reviewed the residents' record, they had one resident with Stage 3 pressure injury before but resident came back to the facility with hospice service in place.

Allegation#6 "Facility illegally evicting residents." LPA interviewed eight residents and eight out of eight residents denied the allegation and reported facility never illegally evicted them. LPA interviewed staff and all denied the allegation. Administrator reported they did not issue any 30 days eviction notice or 3 days notice to resident in the past few months. Administrator also stated that the facility is a residents' home and they never evicted residents illegally and they always follow the protocol and go through the Licensing if needed.

Allegation#7 "Residents are locked in facility." LPA interviewed eight residents and eight out of eight residents denied the allegation and stated that they can leave the facility at any time and they never got locked in the facility." LPA interviewed staff and all denied the allegation and reported they are not a locked facility and they are a secured unit. The facility has a delayed egress system which is the licensing required because they do have dementia residents. They would provide supervision to residents in care.

Allegation#8" Facility staff threatened residents." LPA interviewed eight residents and seven out of eight residents denied the allegation and reported staff never threatened them. LPA interviewed staff and all denied the allegation and stated that they never witnessed or heard any staff threatened the residents. Administrator stated that no one ever reported about this allegation.

Allegation#9 "Facility not safeguarding residents personal belongings." LPA interviewed eight residents and eight out of eight residents denied the allegation and stated that they never lost anything in the facility. LPA interviewed staff and denied the allegation and reported every resident moved in to the facility and they had to complete an inventory form which signed by the residents or responsible party and administrator. The staff would update the form when resident got any new clothes or items in their room. When resident moves out, the staff would review the form and signed by the responsible party or residents and administrator again.

(See LIC9099C for continuation)

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20230417131724

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT MONROVIA	FACILITY NUMBER: 197802560
	VISIT DATE: 08/11/2023

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

Allegation#10 "Residents are denied food" LPA interviewed eight residents and seven out of eight residents denied the allegation and reported staff never denied their request for food. They can get second plate or more snacks if they want. LPA interview staff and all denied the allegation. The staff reported they would never denied resident for food. All staff have access to the kitchen. The resident can get the food at any time they want. Even some residents are on restricted diet, they still would not deny them. The staff still give the food to them but just try to monitor them and will discuss with their primary physician or their responsible party later as the facility is their home.

Based on the interviews conducted with staff and residents, record reviewed and observation, Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore all the allegations are UNSUBSTANTIATED.

Exit interview conducted with Administrator Pamela Ogott and a copy of this report and appeal right was provided.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 08/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/11/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4