197802560-2-15-2024-28-AS-DSIS-D36VNT-20240308153540

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197802560
Report Date: 02/15/2024
Date Signed: 02/15/2024 11:38:23 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
10/03/2023 and conducted by Evaluator Erik Zaragoza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20231003134542

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: 42	DATE:	02/15/2024
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Martha Rosas - Assistant Administrator		TIME COMPLETED:	11:50 AM

ALLEGATION(S):

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Staff are not assisting residents with showering
Staff did not keep facility free of bed bugs

INVESTIGATION FINDINGS:

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Licensing Program Analsyts (LPAs) Erik Zaragoza and Daniel Konishi conducted a subsequent complaint visit in regards to the allegations listed above. LPAs explained the purpose of the visit to Martha Rosas, Assistant Administrator for the facility, and was granted entrance.

The investigation consisted of the following: During the initial visit, LPA Ashley Calderon obtained resident and staff roster, Purchases of Service Reports for 1:1 for Resident #1 (R1), October 2023 Schedule for R1's 1:1 caregiver, Dewery Pest Control Quality Assurance Reports for August and September 2023, obstained shower records and shower schedule, and also interviewed Residents #1 - 6 (R1 - R6), Staff #1 - 6 (S1 - S6), and also Witnesses #1 -2 (W1 - W2). During today's visit, LPAs Erik Zaragoza and Daniel Konishi obtained current staff and resident rosters, resident shower schedule, and interviewed Residents #7 - 9 (R7 - R9).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

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 28-AS-20231003134542

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: 02/15/2024

NARRATIVE

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The investigation revealed the following: In regards to the allegation that "Staff are not assisting residents with showering", it is alleged that residents who require assistance with showering are not getting assistance from caregivers for weeks at a time. During interviews with the residents, seven (7) out of nine (9) did not corroborate the allegation. One resident interviewed stated that they do require assistance with showering and need to seek out a caregiver in the hallways to assist them, and sometimes never get assistance. Other residents interviewed indicated that they do require assistance with showering and do get proper assistance showering from the facility staff. During interviews with staff, none corroborated the allegations that residents are not being assisted with their showering needs. One staff interviewed stated that residents that require assistance with showering are assisted at least two (2) times per week, or even more if necessary. Another staff member explained that sometimes the shower log is not initialed due to time restraints and being busy, however no resident that requires assistance with showering goes over a week without getting help with showering.

In regards to the allegation that "Staff do not keep facility free of bedbugs", it is alleged that a few residents have had problems with bedbugs and that the facility is not doing anything to address it. During interviews with the residents, zero (0) out of nine (9) corroborated the allegation that the facility has a problem with bedbugs. One resident interviewed stated that there was bedbugs in a room identified that had an issue with bedbugs, however they explained that facility staff removed the mattress from the room and replaced it, and that ever since the room has not had a problem with bedbugs. Other residents stated that they have never seen bedbugs within the facility. During interviews with staff, none of them corroborated the allegation that bedbugs have been an issue in the facility. One staff interviewed stated that bedbugs have been reported, and that in response they contacted their pest control company to inspect the rooms for bedbugs, after which no bedbugs were found. A representative from the pest control company was contacted as well, and they stated that there were no bedbugs in the room, and only cockroaches around a facility drain.

Based on statements and interviews conducted with staff, clients, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was provided.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Erik Zaragoza	TELEPHONE: (323) 981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2024

LIC9099 (FAS) - (06/04)

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