198602134-10-6-2021-11-AS-JHAD-C99SW4-20211130131340

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 09/29/2021
Date Signed: 10/06/2021 08:48:18 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
09/22/2021 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20210922131751

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: 74	DATE:	09/29/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	ADMINISTRATOR MELISSA FLORES		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff made false accusations against resident

INVESTIGATION FINDINGS:

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On 09/29/2021 around 11am Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. Today’s complaint investigation was conducted face to face with Administrator Melissa Flores.

The Investigation consisted of the following: On 09/23/2021 LPA Calderon interviewed reporting party. On 09/27/2021 LPA Calderon and Administrator Melissa Flores conducted a tour of the physical plant. LPA obtained copies of Staff and Resident rosters, Resident #1’s record (Needs and Service Plan, Pre-Placement Appraisal, MARS (3 months), Copy of house rules and admission agreement. On 09/27/2021 LPA Calderon interviewed Administrator(S1). On 09/27/2021 LPA Calderon interviewed S2-S3 and on 09/27/2021 LPA Calderon interviewed R2 – R4.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

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-20210922131751

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: 09/29/2021

NARRATIVE

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Allegation: Staff made false accusations against resident.

It is alleged Staff made false accusations against resident. On 09/23/2021 LPA Calderon interviewed R1 for complaint. R1 states that he has been living in facility for 4 months and has never had any issues with staff, other residents or the facility. R1 states that he has been falsely accused of stealing towels, cursing at staff and other residents and stating he would harm himself or other residents. R1 states that the facility is retaliating towards him due to making complaints and wants him to move out. On 09/27/2021 LPA Calderon interviewed S1-S3 all state that R1 has been in violation of house rules, yelling and cursing at staff and other residents, destruction of facility property (kicking a hole in a wall), smoking cigarettes in the facility and smoke marjanuna on facility ground which is against their drug policy. On 09/27/2021 LPA Calderon interviewed R2-R4 all state to know what the house rules are, have seen R1 smoking cigarettes in the facility. R2-R4 do not have any issues with R1 and have not been harmed by R1 at this time. On 09/29/2021 LPA Calderon reviewed medical paperwork on R1. R1 per reports R1 has a hard time dealing with other people.

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 allegation is unsubstantiated.

A telephonic exit interview was conducted with Administrator Melissa Flores, and a hard copy was provided by hand for records

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2021

LIC9099 (FAS) - (06/04)

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