198602134-3-24-2022-11-AS-MVAO-CDPREA-20220421125712

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 03/24/2022
Date Signed: 03/24/2022 03:41:57 PM

Unsubstantiated

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
04/06/2020 and conducted by Evaluator Jade Jordan

COMPLAINT CONTROL NUMBER: 11-AS-20200406150644

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: 70	DATE:	03/24/2022
		UNANNOUNCED	TIME BEGAN:	10:16 AM
MET WITH:	Susan Phan/Melissa Flores		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff are under the influence of an illegal substance while providing care and supervision
Residents do not have planned activities while in care
Residents have access to toxic items while in care
Residents pull cords are not accessible while in care
Facility has inadequate record keeping for medication
Residents medications are being mishandled while in care
Staff are stealing from residents while in care

INVESTIGATION FINDINGS:

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On 03/24/22 Licensing Program Analyst (LPA) Jade Jordan conducted an unannounced subsequent visit to continue investigation regarding allegation(s) above. LPA was met by Facility Administrator Susan Phan, and Quality Assurance Director Melissa Flores, the purpose of the visit was explained.

Investigation consisted of : Resident Interviews, Staff Interviews,Physical tour, Observation Of Med room, Medical Administration Records, Resident Rooms. Copies of the following were requested: Company Substance Abuse Policy, Staff Roster, and Resident Roster.

Regarding Allegation: “Staff are under the influence of an illegal substance while providing care and supervision”
Interviews conducted with Quality Assurance Director revealed that the company has a substance abuse policy. The policy prohibits the sale, use, or possession of drugs or alcohol while in the workplace, or while on the company property, or business. If the company has a reasonable suspicion, based on physical, psychological or other behavioral signs an investigation will be conducted, and the employer may request the employee to submit to a drug or alcohol test.

Unsubstantiated

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: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

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 5

Control Number 11-AS-20200406150644

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: 03/24/2022

NARRATIVE

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Q/A Director, who was the former administrator during the time of allegations were received, stated that they do not witness any employees whom they have a suspicion of alcohol or drug use. Interviews with residents generally stated that they did not witness any staff being under the influence of any drugs while providing care and supervision. During the visit LPA did not observe any suspicion of staff members being under the influence. Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

Regarding Allegation: “Residents do not have planned activities while in care.”
Interviews with Activity’s Director revealed that in March of 2020 the facility shut down communal activities, including dining due to the situation surrounding Corona Virus disease. Normal Activities were put on hold, and other activities such as coloring packets, virtual visits, and room visit were replaced to keep residents in care safe and allow for social distancing. Actvities Director stated that Tv’s are not turned off, if residents do not want to participate in planned activities. Interviews with residents generally stated that they had not witnessed Televisions being turned off, if residents did not want to participate in planned activities. Residents stated that in 2022, they had resumed normal activities such as Karaoke, Current Events, Exercise Chair, and Gardening. LPA observed residents in the activity room interacting, and observed a monthly activities calendar, with planned activities. Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

******************************Continued on 9099 C************************************

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 11-AS-20200406150644

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: 03/24/2022

NARRATIVE

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Regarding Allegation: “Residents have access to toxic items while in care”

LPA observed a dining hall called “Pinks café” that is open to residents during mealtimes. Inside the dining is a half door that is locked, with a latch in front of a full door, that also locks. LPA observed a locked storage in the kitchen, that contains kitchen toxins. During the tour of the kitchen, LPA did not observe any toxic chemicals out of the locked storage. LPA confirmed with Administrator that the kitchen is a restricted area to staff, and residents are not allowed. Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

Regarding Allegation: “Residents pull cords are not accessible while in care”

LPA Sampled 7 resident rooms in the facility. All rooms were observed to have 4 pull chords.

Two chords were observed on the wall next to the bed, freely accessible to pull and in good conditions, and two chords were observed next to the toilet stall in resident bathrooms. All were in working condition. Interviews with residents in care all generally stated that” they have no obstructions preventing them from using the pull chord.” Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

*****Continued on 9099C***********************************

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20200406150644

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: 03/24/2022

NARRATIVE

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Regarding Allegation(s): “Facility has inadequate record keeping for medication”,

“Residents medications are being mishandled while in care”

Interview with Med Tech revealed that A Medical Administration Record (MAR) is kept for every resident in care who takes medications at the facility. One Binder is used for all residents for the month, and has the listed medications the resident takes in the book. The MAR’s is signed at the time medication is administered. The facility passes out meds, using a roll cart, medications are not pre-prepped. Medication are stored in the locked cart, which is in a locked Medication room. Generally medications are administered during mealtimes. If a resident is unavailable for a meal, the med tech will go to the resident’s room to provide. Interviews with residents in care all generally stated that their medication is provided accurately, and that they have no issues receiving the correct medications. LPA observed the Medical Administration Records for the month of March. Sampled Pages were signed for all medication that was issued.” Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

Regarding Allegation: “Staff are stealing from residents while in care”

Interviews with Quality Assurance Director revealed that they are not receiving complaints

About any individual staff stealing from residents. Interviews with residents in care generally stated that staff are not stealing from them. LPA did not observe any theft taking place while touring the facility.

Therefore, based on Interviews, Record Review and Observation the Department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

An Exit interview was conducted, and a copy of this report was provided.

No citations were issued during this vist.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20200406150644

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: 03/24/2022

NARRATIVE

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Regarding Allegation: “Residents have access to toxic items while in care”

Regarding Allegation: “Residents pull cords are not accessible while in care”

LPA Sampled 7 resident rooms in the facility. All rooms were observed to have 4 pull chords.

An Exit interview was conducted, and a copy of this report was provided.

No citations were issued during this vist.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 03/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/24/2022

LIC9099 (FAS) - (06/04)

Page: 5 of 5