197802560-6-30-2025-28-AS-DSIS-DJGNXD-20250711105057

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197802560
Report Date: 06/30/2025
Date Signed: 06/30/2025 03:28:56 PM

Unsubstantiated

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
06/23/2025 and conducted by Evaluator Daniel Konishi

COMPLAINT CONTROL NUMBER: 28-AS-20250623135323

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: 43	DATE:	06/30/2025
		UNANNOUNCED	TIME BEGAN:	09:35 AM
MET WITH:	Martha Rosas, Assistant Administrator		TIME COMPLETED:	03:40 PM

ALLEGATION(S):

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Staff did not keep the facility free from infestation.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs) Daniel Konishi and Gabriela Castro conducted a 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 was granted entrance. Executive Director, Pamela Ogot arrived shortly after and was explained the purpose of the visit.

The investigation consisted of the following: LPAs obtained resident and staff roster, Purchases of Service Dewey Pest Control Quality Assurance Reports for March 21, 2025, April 22, 2025, May 19, 2025, June 18, 2025, and June 30, 2025. LPAs interviewed Residents #1 (R1) to Resident #5 (R5), Assistant Administrator, Staff#1 (S1) to Staff #4 (S4), and also the Pest Control company representative.

In regards to the allegation that "Staff did not keep the facility free from infestation", it is alleged that there are bed bugs and cockroaches in the facility. Four (4) out of five (5) residents interviewed stated that there were cockroaches found in the bedroom, hallways, and dining hall in the past.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Daniel Konishi	TELEPHONE: 323-981-3978
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

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-20250623135323

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: 06/30/2025

NARRATIVE

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However, when the residents reported this to staff, the housekeeping and maintenance staff immediately treated the bedroom, hallways, and dining hall. Five (5) out of five (5) staff interviewed denied the allegation. Assistant Administrator interviewed stated that the facility contacted their pest control company to inspect the rooms for bedbugs and cockroaches, after which no bedbugs or cockroaches were found. Assistant Administrator also stated that the pest control company visits the facility. Based on record review, Dewey Pest Control, Quality Assurance Reports dated March 21, 2025, April 22^nd, 2025, May 19, 2025, June 18, 2025, and June 30, 2025, that LPAs observed no pest issues verified on the reports. One (1) out of five (5) staff interviewed stated that whenever a bed bug is found in the bedroom, the facility would immediately replace the bed mattress, linens, sheets, blankets, pillows and other bed furnishings. Pest control company representative stated that there have no bedbugs observed in the facility and only cockroaches around a facility drain. During the facility tour, LPAs observed two small ants in one of the kitchen cabinets but did not observe any cockroaches or bedbugs in the kitchen, dining hall, activity room, four residents’ bedrooms at the first floor, and the four residents’ bedrooms at the second floor.

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 to the Executive Director, Pamela Ogot.

SUPERVISOR'S NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR NAME: Daniel Konishi	TELEPHONE: 323-981-3978
LICENSING EVALUATOR SIGNATURE:	DATE: 06/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2025

LIC9099 (FAS) - (06/04)

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