198602134-12-15-2020-11-AS-MVAO-BYXT5Q-20210309132554

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 12/14/2020
Date Signed: 12/15/2020 08:08:58 AM

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
12/07/2020 and conducted by Evaluator Jade Jordan

COMPLAINT CONTROL NUMBER: 11-AS-20201207162944

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:	12/14/2020
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Melissa Flores Admin		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff did not safeguard resident's personal property

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jade Jordan initiated a 10-day complaint investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Administrator Melissa Flores.

LPA Jordan interviewed Reporting Party, and Administrator regarding the complaint. LPA Jordan requested documentation (Personal Inventory Form, Resident Roster, Staff Roster, Doc’s Pertaining to personal belongings reported missing) regarding the complaint allegation.
In regard to the allegation: “ Facility staff did not safeguard resident’s personal property”

***************This report is continued on 9099 C page**************************

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2020

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-20201207162944

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: 12/14/2020

NARRATIVE

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The investigation consisted of the following:

On 12/07/20 the department received a complaint indicating the above allegation. On 12/14/20 LPA Jordan investigated, and interviewed Administrator, and reporting party regarding the complaint. Administrator states, that that she had not received any recent complaints from residents regarding loss/stolen personal property. Reporting party indicated that the resident in care did not give a specific time frame about when they believed personal property was gone missing, but rather over a period of time, living at the facility.

Administrator could only recall 1 resident in care, who has made an ongoing complaint, which she indicated was substantiated by licensing in 2017. After investigation, LPA Jordan determined that the allegation above had been previously addressed, and it regarded the same previous items reported, to not have been safeguarded by the facility.

Therefore; Based on LPAs interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED.

Due to this being a previous allegation, which was cited and substantiated, no new citations were issued during this visit.

An exit interview was conducted, and a copy of this report was given the Administrator.

Advised Admin to sign, and submit a copy of this report back to Jade.Jordan@dss.ca.gov, or via fax at 323-981-1781.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 12/14/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/14/2020

LIC9099 (FAS) - (06/04)

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