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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601845
Report Date: 10/22/2024
Date Signed: 10/22/2024 04:21:25 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
10/17/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20241017094648
FACILITY NAME:A SPLENDOR LIVING - THE GLENDORA INCFACILITY NUMBER:
198601845
ADMINISTRATOR:CHRIS JENGFACILITY TYPE:
740
ADDRESS:452 SELLERS ST.TELEPHONE:
(626) 594-0152
CITY:GLENDORASTATE: CAZIP CODE:
91741
CAPACITY:34CENSUS: 6DATE:
10/22/2024
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Rachel De Chavez, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
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6
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9
Facility staff pushed a resident.
Facility staff did not treat resident with dignity and respect.
INVESTIGATION FINDINGS:
1
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3
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5
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9
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13
Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation on the allegations listed above. LPA arrived unannounced and met with Administrator Rachel De Chavez. The purpose of the visit was explained.

LPA obtained copies of the resident roster, staff roster, and documents pertaining to Resident #1. Interviews were held with the Administrator, Staff #1 - #6, and Residents #1 - #4.

The investigation revealed the following:
Allegation - Facility staff pushed a resident. LPA interviewed Staff and Residents for this allegation. Administrator and Staff have not heard or seen any staff pushing a resident. They stated they received training on personal rights and do not shove or push any residents. 3 out of 4 Residents interviewed stated they have not been pushed or witnessed any staff doing so. One indicated that 2 staff had pushed resident in the past but did not provide specific details.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
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 2
Control Number 28-AS-20241017094648
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: A SPLENDOR LIVING - THE GLENDORA INC
FACILITY NUMBER: 198601845
VISIT DATE: 10/22/2024
NARRATIVE
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Allegation - Facility staff did not treat resident with dignity and respect. Administrator stated facility staff and temporary staff from the staffing agency are provided with training on resident rights. She was not informed by residents that staff was mistreating the resident. Staff interviewed denied speaking or treating residents inappropriately. They stated they are respectful and accommodating to residents. When a resident requests for assistance and staff is not available right away, they would explain the reason to the resident. LPA interviewed 4 residents. 3 out of 4 stated staff treat them with respect and are accommodating. They are content and feel safe residing at the facility.

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.



An exit interview was held and a copy of this report along with the appeal rights was provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2