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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601845
Report Date: 09/28/2023
Date Signed: 10/13/2023 10:18:55 AM

Document Has Been Signed on 10/13/2023 10:18 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
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: DATE:
09/28/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
01:30 AM
MET WITH:Holly Yuo, Licensee and Melissa Flores, AdministratorTIME COMPLETED:
02:10 PM
NARRATIVE
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A virtual Informal Meeting was held today, for the purpose of discussing and issuing citations, specifically for the allegation: Facility allowed adults to film inside of the facility without obtaining permission from licensing, regarding complaint# 28-AS-20221219172710. Present during today's meeting were Licensing Program Manager (LPM) Fernando Fierros, LPM Lisa Hicks, Licensee Holly Yuo, and Facility Administrator, Melissa Flores, via invite from Holly. Licensees Peter and Jan Yuo were unable to attend today's meeting. However, Holly states she has authorization from Peter and Jan to speak on their behalf.

During todays' meeting, it was discussed that during the complaint investigation on 12/27/2022, LPA Maldonado discovered that a filming crew was allowed to film inside the facility, including residents, without proper consent from residents and/or their responsible parties. The investigation also revealed that the filming was not a planned activity for residents, proof of written consent was not obtained, and the Administrator at the time, Jason Chuang, allowed this at least one other time prior.
Holly stated to have been unaware of the filming occurred during the time, and believes Jason made this decision on his own. Melissa stated that moving forward, the facility does not have plans of allowing any filming. However, should it come about, they will ensure to notify all respective parties, obtain written consent, comply with all Title 22 Regulations, and not violate the Personal Rights of any residents.
The following material was provided to Licensee, Holly, and Administrator Melissa:
  • 2-5800 Guidelines for Video Surveillance
  • Regulation 87468- Personal Rights
  • Regulation 87468.1- Personal Rights of Residents in All Facilities
  • Regulation 87468.2- Additional Personal Rights of Residents in Privately Operated Facilities
Per California Code or Regulations, Title 22, Division 6, Chapter 8, citations were issued and noted on the LIC809-D.
An exit interview was conducted with Licensee, Holly and Administrator, Melissa. A copy of this report and appeal rights were provided via email, for signature. Signature provided on hard copy.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Valeria Maldonado
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/13/2023 10:18 AM - It Cannot Be Edited


Created By: Valeria Maldonado On 09/28/2023 at 02:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: A SPLENDOR LIVING - THE GLENDORA INC
FACILITY NUMBER: 198601845

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2023
Section Cited
CCR
87468.1(a)(3)

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87468.1Personal Rights of Residents in All Facilities
(a) Residents...shall have all of the following personal rights:(3)To be free from...actions of a punitive nature, such as...interfering with daily living functions...
This requirement was not met as evidenced by:
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Administrator will conduct In-service training with staff regarding Resident's Personal Rights and submit proof to LPA, via email, by POC due date. Administrator will also submit a written plan on how the facility will ensure to not violate resident's personal rights in the future by POC due date.
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Based on interviews, the licensee did not comply with the section cited above by allowing a film crew to film residents without proper consent and interfering with their activities of daily living, which poses a potential Health, Safety, or Personal Rights risk to persons in care.
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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.
SUPERVISOR'S NAME:Fernando Fierros
LICENSING EVALUATOR NAME:Valeria Maldonado
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023


LIC809 (FAS) - (06/04)
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