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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197802560
Report Date: 07/09/2024
Date Signed: 07/09/2024 04:27:19 PM

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
07/02/2024 and conducted by Evaluator Bennette Pena
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240702104018
FACILITY NAME:GLEN PARK AT MONROVIAFACILITY NUMBER:
197802560
ADMINISTRATOR:ACHARYA, NIRJARAFACILITY TYPE:
740
ADDRESS:110 N MOUNTAIN AVETELEPHONE:
(626) 357-6818
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY:49CENSUS: 43DATE:
07/09/2024
UNANNOUNCEDTIME BEGAN:
09:29 AM
MET WITH:Pamela Ogot - Administrator
Martha Rosas - Assistant Administrator
TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff administers medications to resident without prior consent.
Staff do not administer medications to residents as needed.
Staff handles residents in a rough manner.
Staff do not respond to resident's call light in a timely manner.
Staff does not treat resident with dignity or respect.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced initial complaint visit to investigate the above allegations. Upon arrival LPA met with Martha Rosas, Assistant Administrator and explained the purpose of the visit. At 11:35 am, Pamela Ogot, Adminstrator arrived and assisted LPA with the investigation.
During today’s visit, LPA toured the facility’s common areas and inspected random rooms to check call lights in Room # 4 and Room #8. LPA obtained resident & staff roster, Unusual Incident/Injury Reports (SIRs) involving Resident #1 (R1)-Resident #2 (R2) and Resident #7 (R7) (March 2024-July 2024), Staff in-service training logs on Residents' Rights (March 2024) and Medication (June 2023-Nov 2023), Residents Incontinent Tracking (June-July 2024). LPA also reviewed and obtained Resident #1 (R1)-Resident #2 (R2) and Resident #7 (R7) records and files such as Face Sheets, Admission Agreements, Physician's Reports, Needs and Services Plans and Medication Administration Records (MARs) for June 2024-July 2024. LPA interviewed Resident #1 (R1) – Resident #6 (R6), Staff #1 (S1)-Staff #3 (S3) in person, Staff #4 (S4) - Staff #7 (S7) telephonically. Resident #7 (R7) has moved out of the facility, therefore not interviewed. ******CONTINUED ON LIC9099-C*****
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette PenaTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
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 28-AS-20240702104018
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: 07/09/2024
NARRATIVE
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In regards to allegation: Staff do not respond to resident's call light in a timely manner. It is alleged that staff members do not respond to residents call light because they are chit chatting with other resident. Staff interviewed indicated that call lights are in operational condition. Staff stated that residents press the call light if they need help. The receptionist gets the call and then page for attention and help from caregivers on the floor. S6-S7 denied the allegation and stated that the allegation never happened. Staff stated that they always respond to the call light and if they are busy attending to other residents, they would inform the front desk or ask another staff member's help to attend to the call. Staff also indicated that they respond to call lights in less than (5) minutes. LPA toured Resident rooms #4 and #8 and tested the call lights in which staff responded to in less than (1) minute. Residents interviewed indicated that they have not had any issues with the call lights. Residents indicated that when they need assistance, they activate the call button and that staff arrive promptly. Staff and Resident interviews were unable to corroborate this allegation.

In regards to allegation: Staff does not treat resident with dignity or respect. It is alleged that staff are not applying cream when changing a resident who is incontinent and has skin issue. Staff interviewed stated that they have not observed any resident being treated disrespectfully. Staff interviewed stated that residents are monitored and checked consistently, either every 2 hours or as needed. S2 stated that R7 had the staff's full attention and she was being monitored a lot. Staff indicated that they apply the cream to R7 and other incontinent residents as required. Staff also indicated that Home Health comes to the facility to monitor, check and manage R7's condition. Medication Administration Record (MAR) for R7 was reviewed and showed that cream was applied consistently, 3x a day as prescribed. Interviews conducted with residents indicated that staff members treat them with dignity and respect. Residents stated that they feel safe and comfortable in the facility. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with staff, residents, review of resident 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, a copy of this report was provided to Pamela Ogot, Administrator.

SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette PenaTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 28-AS-20240702104018
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: 07/09/2024
NARRATIVE
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The investigation revealed the following:

In regards to allegation: Staff administers medications to resident without prior consent. It is alleged that a staff gives a resident sleeping medication without the family member’s consent. (7) out of (7) staff interviewed denied the allegation. Staff stated that they only administer medications based on Physician's orders and document it on Medication Administration Record (MAR). Staff indicated that they never administer medication without the residents' consent. Staff also stated stated that medications including PRNs are prescribed and approved by the residents’ doctor and discussed with the family and the resident before being finalized. (6) out of (6) residents interviewed denied the allegation and reported that it never happened on them and never heard that happened in the facility too. Residents interviewed stated that they know what medications they are taking and have not heard or seen staff give them or others any medications that are not prescribed by their doctors. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to allegation: Staff do not administer medications to residents as needed. It is alleged that a staff will not administer the resident’s medication as requested. (7) out of (7) staff interviewed denied the allegation. Staff stated that if a resident ask them to apply cream, then they do it. Staff indicated that there are some creams that only Med Techs can apply because it is a prescribed medication. Staff stated that they follow what the doctors orders on medication for all residents. Residents interviewed do not corroborate the allegation. Residents stated that staff are nice and assist them when they ask. (4) out of (6) residents interviewed are incontinent and stated that the staff apply the cream on them whenever they get cleaned/changed. Some residents stated that they never experience a staff deny applying cream on them if they ask. Therefore there was insufficient evidence to corroborate with this allegation.

In regards to allegation: Staff handles residents in a rough manner. It is alleged that a staff handles a resident in a rough manner when showering. Staff interviewed stated that they have not heard or witnessed any staff handled resident in a rough manner. Staff stated that they receive training on Residents rights on a regular basis and facility has zero tolerance policy on abuse. S1-S2 stated that they never received any report concerning any staff handling residents in a rough manner. S5 denied ever treating any resident aggressively nor handling any resident in a rough manner. R2 stated that he thought he was pushed by S5 in the shower chair but was not sure if S5 was playing with him or was serious. (5) out of (6) residents interviewed denied the allegation and indicated that they are satisfied with the services and do not have any concerns. Residents interviewed stated that staff are helpful and assist them whenever they asked. Some residents stated that they were never treated aggressively by any staff. Therefore there was insufficient evidence to corroborate with this allegation.

SUPERVISOR'S NAME: David SicairosTELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Bennette PenaTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3