198602134-9-29-2020-11-AS-MCAA-BVQ2XM-20201125164718

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 09/24/2020
Date Signed: 09/29/2020 03:09:15 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/04/2020 and conducted by Evaluator Erik Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200904104305

FACILITY NAME:	GLEN PARK AT LONG BEACH		FACILITY NUMBER:	198602134
ADMINISTRATOR:	PINK, MARINA E		FACILITY TYPE:	740
ADDRESS:	1046 E 4TH ST		TELEPHONE:	(562) 432-7468
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	208	CENSUS: 62	DATE:	09/24/2020
		UNANNOUNCED	TIME BEGAN:	10:11 AM
MET WITH:	Melissa Flores, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff unlawfully evicted resident while in care

INVESTIGATION FINDINGS:

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On this date, Licensing Program Analyst (LPA) Erik Brown conducted an unannounced complaint tele-visit to deliver findings. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Melissa Flores, the facility Administrator.

During the initial tele-visit on 9/10/2020, LPA discussed the allegation with Administrator Melissa Flores. LPA Brown interviewed Staff #1-2 (S1-S2), regarding the complaint. LPA Brown also requested documentation (R1’s hospital admission records, physicians report, needs and services plan) regarding the complaint allegation.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Erik Brown	TELEPHONE: (747) 230-2283
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

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 11-AS-20200904104305

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT LONG BEACH	FACILITY NUMBER: 198602134
	VISIT DATE: 09/24/2020

NARRATIVE

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LPA Brown received requested documentation pertaining to this investigation on 9/10/2020.

The investigation revealed the following for allegation:

(Staff unlawfully evicted resident while in care)

Based on interviews with Staff #1-2 (S1-S2) and the licensed clinical social worker, R1 was sent out to Norwalk Community Hospital via non-emergency ambulance for being covid positive and needing assistance with self-isolation. However, R1 never made it to Norwalk Community Hospital because he had respiratory failure in the ambulance vehicle. R1 was then re-routed to the nearest hospital which was Saint Mary’s hospital. The facility transferred R1 to the hospital because they were not able to keep R1 safely quarantined at the facility, which presented a risk for other residents in care. The facility Administrator stated that R1 had recently tested positive for Covid-19 and was suffering a change of condition before being transferred to the hospital. Administrator also stated that R1 needed a controlled environment to conduct R1’s isolation and quarantine due to R1’s advanced dementia and potential to wander out of his room.

Based on LPA Brown’s observations, the records that were reviewed (R1’s hospital admission records, physicians report, needs and services plan, Special Incident Report dated 9/4/2020), and the interviews that were conducted, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations is unsubstantiated.

A telephonic exit interview was conducted with Administrator Melissa Flores, and an electronic copy was provided via email for signature.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Erik Brown	TELEPHONE: (747) 230-2283
LICENSING EVALUATOR SIGNATURE:	DATE: 09/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2020

LIC9099 (FAS) - (06/04)

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