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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 10/24/2025
Date Signed: 10/24/2025 04:57:02 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/17/2025 and conducted by Evaluator Troy Watson
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20251017130143
FACILITY NAME:GLEN PARK AT LONG BEACHFACILITY NUMBER:
198602134
ADMINISTRATOR:MICHAEL MENDOZAFACILITY TYPE:
740
ADDRESS:1046 E 4TH STTELEPHONE:
(562) 432-7468
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY:208CENSUS: 101DATE:
10/24/2025
UNANNOUNCEDTIME BEGAN:
08:01 AM
MET WITH:Shenick Jackson - Office ManagerTIME COMPLETED:
04:56 PM
ALLEGATION(S):
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Staff does not prevent resident from smoking inside the facility.
INVESTIGATION FINDINGS:
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On 10/24/2025 Licensing Program Analyst (LPA) Troy Watson made an unannounced complaint visit to the facility listed above. LPA Watson was greeted by the Office Manager Shenick Jackson and explained the purpose of this visit is to investigate the allegation mentioned above.

The investigation consisted of the following:

On 10/24/2025 LPA Watson requested, received and reviewed the following documents: Resident Roster, Staff Roster, Unusual Incident Report, Psychiatric Emergency Team Assessment, and Placement for Evaluation and Treatment.
CONTINUED ON LIC9099-C

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
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 3
Control Number 11-AS-20251017130143
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
VISIT DATE: 10/24/2025
NARRATIVE
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On 10/24/2025 LPA Watson conducted interviews with Resident #2 - Residents #11 (R2-R11). An attempt to interview Resident#1 (R1) was made but the resident was no longer at the facility because is currently in College Medical Center in the City of Long Beach on a 51/50 hold. LPA Watson also conducted interviews with Staff#1 – Staff #5 (S1-S5). LPA Watson toured the facility with the Assistant Administrator Catherine Dacara and found the facility clean and in good repair. The investigation revealed the following:

Allegation: Staff do not prevent residents from smoking inside the facility.

On 10/24/2025 LPA Watson interviewed Staff #1-Staff #5 (S1-S5). Of those interviewed, 5 out of 5 staff denied the above allegation. On 10/24/2025 LPA Watson interviewed Residents #2 – Residents #11 (R2-R11). An attempt to interview Resident#1 (R1) was made but R1 was no longer at the facility at the time of the interviews. Of those interviewed 10 out of 11 denied the above allegation. LPA Watson completed interviews with 10 residents at the facility and every resident interviewed was asked the question, does staff allow residents to smoke in the facility, and all residents interviewed answered no. LPA Watson interviewed 5 staff members at the facility listed above and all staff members were asked, do you allow residents to smoke inside the facility, and all staff interviewed answered no.

CONTINUE ON LIC9099-C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20251017130143
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
VISIT DATE: 10/24/2025
NARRATIVE
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Based on record reviews, staff and client interviews and observations there is insufficient evidence to support the allegation: “Staff do not prevent residents from smoking inside the facility.” Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted with the Administrator Assistant, and a copy of this report was provided.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3