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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197802560
Report Date: 08/01/2025
Date Signed: 08/01/2025 01:20:07 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
07/25/2025 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20250725115853
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: 42DATE:
08/01/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Pamela Ogot, AdministratorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Licensee does not ensure staff are appropriately trained to assist residents who have fallen.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Konishi conducted an initial 10-day complaint visit in regards to the allegation listed above. LPAs explained the purpose of the visit to Martha Rosas, Assistant Administrator for the facility, and the LPA was granted entrance. Executive Director, Pamela Ogot arrived shortly after and the LPA explained the purpose of the visit.

The investigation consisted of the following: LPA obtained copies of the Resident & Staff Rosters, Unusual Incident/Injury Reports, Facility’s Fall prevention policies, and staff training documents regarding falls. LPA toured the facility's common areas. LPA interviewed the Executive Director, Assistant Administrator, Staff #1 (S1) - Staff #4 (S4) and Resident #1 (R1) - Resident #5 (R5).

The investigation revealed the following: in regards to the allegation “Licensee does not ensure staff are appropriately trained to assist residents who have fallen.” It is alleged that when residents have fallen out of their wheelchair or out of bed, they just need help getting back up instead, the staff called 9-1-1.
Substantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
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 28-AS-20250725115853
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: GLEN PARK AT MONROVIA
FACILITY NUMBER: 197802560
VISIT DATE: 08/01/2025
NARRATIVE
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Five (5) out of five (5) residents interviewed feel safe at the facility. The Executive Director, Assistant Administrator, four (4) out of four (4) staff interviewed denied the allegations stating that the facility’s policy regarding falls is contacting 9-1-1 if the resident has a unwitnessed fall or has Dementia. However, based on record review, facility’s Fall Policy states that if the resident is severely hurt or severe pain, call 9-1-1. Based on record review, Special Incident Report dated 7/27/2025, 7/20/2025, and 7/13/2025, the facility called 9-1-1 due to a fall. These SIRs were missing the facility care staff conduct an assessment checking for visible injuries or severity of pain prior to contacting 9-1-1. The residents had no injuries noted. Based on record review, staff’s most recent documented in-service on fall prevention was conducted on 03/26/2025. However, based on staff interview, the Assistant Administrator and one (1) of the staff interviewed admitted that there was a recent staff in-service held on 07/26/2025, regarding an updated Fall Policy that indicates the facility hiring a Licensed Vocational Nurse that would help determine if the resident’s fall is a medical emergency in which the facility was unable to provide documentation of that in-service. Therefore, there was sufficient supportive evidence to concur with the reported allegation.

Based on LPA's interviews conducted with the residents and staff, the preponderance of evidence standard has been met, therefore the allegations are found SUBSTANTIATED. California Code of Regulations Title 22, Division 6, and Chapter 1 are being cited on the attached LIC 9099D.

An exit interview was held with the Executive Director, Pamela Ogot, and a copy of this report and appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20250725115853
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT MONROVIA
FACILITY NUMBER: 197802560
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2025
Section Cited
CCR
87208(a)(6)
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a) The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation and may be cited for not doing so pursuant to Health and Safety Code section 1569.49. The plan and related materials shall be on file in the facility and shall be submitted to the licensing agency with the license application. Any significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval. The plan and related materials shall contain the following:
(5) Staffing plan, qualifications and duties.

This evidence has not been met as required by:
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Executive Director will submited updated Fall policy and procedures and conduct a staff training and send staff training agenda and sign-up sheet to the LPA by the POC due date.
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Based on record review and staff interview, the facility is not following the Plan of Operations regarding the fall policy and procedures, the staff called 9-1-1 without doing an assessment to check for severity of pain and injuries.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Daniel Konishi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/01/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2025
LIC9099 (FAS) - (06/04)
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