198602134-7-15-2026-11-AS-EMAZ-DWQSPE-20260807140300

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 07/15/2026
Date Signed: 07/15/2026 06:34:44 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
04/21/2026 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20260421155314

FACILITY NAME:	GLEN PARK AT LONG BEACH		FACILITY NUMBER:	198602134
ADMINISTRATOR:	ACE HUYNH		FACILITY TYPE:	740
ADDRESS:	1046 E 4TH ST		TELEPHONE:	(562) 432-7468
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	208	CENSUS: 105	DATE:	07/15/2026
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Ace Huynh		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff do not ensure reporting requirements are being followed
Staff did not ensure resident was provided medical care

INVESTIGATION FINDINGS:

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On 07/14/2026, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced subsequent Complaint Visit to the facility listed above. LPA met with Ace Huynh, Administrator, and the purpose of today’s visit was explained. LPA was granted entry into the facility.
The investigation consisted of the following:
During today's visit, LPA interviewed Staff S6 and S7 and conducted a medication review for two (2) residents.
During the initial visit conducted on 04/30/2026, LPA inspected the facility, interviewed Staff S1, interviewed Resident R1-R12, and received documents pertinent to the investigation. The following documents were received and reviewed Staff Roster, Resident Roster, Physician’s Report (dated 08/04/2025), Appraisal/Needs and Service Plan (dated 04/17/2026), Internal Resident Incident Report (various dates), After Visit Summary (dated 11/19/2025 and 07/08/2025), St. Mary Medical Center – Long Beach Discharge Instruction Document (dated 04/17/2026), Medication Administration Records (MAR) (March 2026 and April 2026), and Memory Care Communication Log (04/17/2026 through 04/29/2026).
The investigation revealed the following:

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

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-20260421155314

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT LONG BEACH	FACILITY NUMBER: 198602134
	VISIT DATE: 07/15/2026

NARRATIVE

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During interviews with Residents R1-R12, were asked if they feel staff meet reporting requirements, informing responsible party or physician, twelve (12) out of twelve (12) stated they feel staff meet reporting requirements.
During an interview with a resident’s family member W1, was asked if the facility stated the POA was not made aware of the incident until they visit the facility on 04/15/2026.

During the course of the investigation, LPA was able to find evidence to support the allegation. Based on LPAs observations and 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. California code of Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D.

Allegation: Staff do not ensure resident was provided medical care

The allegation alleges that a resident was not sent to the hospital to be evaluated after not eating meals and being observed with feces in their mouth.
During record review, LPA received and reviewed two Internal Resident Incident Reports, one is dated 04/13/2026 at 3:20am that indicates R1 was observed with feces in their mouth. Staff attempted to assist R1 and R1 was combative and went back to sleep. Staff attempted to assist R1 again 10 minutes later and R1 was still combative and went back to sleep. When AM shift arrived, Staff tried to assist with brushing teeth and R1 was combative. The second Internal Resident Incident Report is dated 04/13/2026 at 3:15am, S2 was informed R1 was observed with feces in their mouth and if R1 should be sent out. S2 informed Staff that R1 could be sent out for altered mental status but may be returned right away if R1 has a diagnosis of dementia. Under Action Taken indicates S2 to follow up with Primary Care Physician (PCP) and family. LPA observed in the Contact Made section there was no indication if the Physician or Responsible Party were notified. Additionally, LPA received and reviewed St. Mary Medical Center – Long Beach Discharge Instruction Document (dated 04/17/2026) that indicates R1 was examined due to abdominal pain and acute chest pain during respiration.
During interviews with Staff S1-S7, were asked if residents receive medical care when needed, seven (7) out of seven (7) stated resident receive medical care when needed.
During interviews with Residents R1-R12, were asked if staff ensure they receive medical care when needed, twelve (12) out of twelve (12) stated yes they receive medical care when needed.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260421155314

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT LONG BEACH	FACILITY NUMBER: 198602134
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/15/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/29/2026 Section Cited CCR 87211(a)(1)(D)	1 2 3 4 5 6 7	87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events...(D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents,	1 2 3 4 5 6 7	Staff retraining regrading reporting incidents to CCL and Responsible party was conducted in June 2026. The Administrator will email the staff training log to LPA at Wendy.Gibbs@dss.ca.gov by POC due date.
	8 9 10 11 12 13 14	or unexplained absence of any resident. This requirement was not met based on record review, interviews, and observations, there was no incident reports submitted to CCL for the incidents of R1 on 4/13/2026 or of R1's Emergency Room visit on 04/17/2026, which poses a heath and safety risk.	8 9 10 11 12 13 14
Type B 07/29/2026 Section Cited CCR 87411(d)(5)	1 2 3 4 5 6 7	87411 Personnel Requirements – General (d) All personnel shall be given on the job training or have related experience in the job assigned to them. This training and/or related experience shall provide knowledge of and skill in the following, as appropriate for the job assigned and as evidenced by safe	1 2 3 4 5 6 7	Administrator will retrain staff on documenting communication with the Primary Care Physician and Responsible Party of resdients regarding incident that occur. Administrator will email the staff training log to LPA at Wendy.Gibbs@dss.ca.gov by POC due date.
	8 9 10 11 12 13 14	and effective job performance: (5) Knowledge necessary in order to recognize early signs of illness and the need for professional help. This requirement was not met based on an incident of R1 who was observed with feces in their mouth on 04/13/2026 and was not evaluated by a medical professional on 04/17/2026 due to abdominal pain.	8 9 10 11 12 13 14

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 6

Control Number 11-AS-20260421155314

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT LONG BEACH	FACILITY NUMBER: 198602134
	VISIT DATE: 07/15/2026

NARRATIVE

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During an interview with a resident’s family member W1, stated the POA was not made aware of the incident until they visited the facility on 04/15/2026 and were told by a nurse they were not going to send R1 out to the hospital due to their given health. R1 was later seen at the hospital on 04/17/2026 for abdominal pain and acute chest pain during respiration.

An exit interview was conducted with Ace Huyhn, Executive Director, and a copy of this report and the Appeals Rights were provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 11-AS-20260421155314

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT LONG BEACH	FACILITY NUMBER: 198602134
	VISIT DATE: 07/15/2026

NARRATIVE

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Allegation: Staff do not ensure reporting requirements are being followed
The allegation alleges it was not reported when a resident’s medication was not taken and when a resident was observed with feces in their mouth.
During record review, LPA received and reviewed two Internal Resident Incident Reports, one is dated 04/13/2026 at 3:20am that indicates R1 was observed with feces in their mouth. Staff attempted to assist R1 and R1 was combative and went back to sleep. Staff attempted to assist R1 again 10 minutes later and R1 was still combative and went back to sleep. When AM shift arrived, Staff tried to assist with brushing teeth and R1 was combative. LPA observed in the Contact Made section under Physician was indicated “no,” and under the Responsible Party it was not indicated whether they were contacted. The second Internal Resident Incident Report is dated 04/13/2026 at 3:15am, S2 was informed R1 was observed with feces in their mouth and was asked if R1 should be sent out. S2 informed Staff that R1 could be sent out for altered mental status but may be returned right away if R1 has a diagnosis of dementia. Under Action Taken indicates nurse to follow up with Primary Care Physician (PCP) and family. LPA observed in the Contact Made section there was no indication if the Physician or Responsible Party were notified. Staff were unable to provide documentation that the Physician or Responsible Party were notified.
Additionally, LPA received and reviewed St. Mary Medical Center – Long Beach Discharge Instruction Document dated 04/17/2026, indicates R1 was examined due to abdominal pain and acute chest pain during respiration.
LPA observed on the eMAR that R1 refused medications on 04/02/2026 and 04/13/2026. LPA did not observe any notes or indication that the POA or Physician was notified of the medication refusals.
Additionally, during records review and LPA observed the following: R1 has a POA, according to a document titled Power of Attorney for California (dated on 05/11/2024). This POA is also mentioned on the LIC 601 has the person responsible for final affairs, payment for care and legal guardian if any and this is also indicated on LIC 603 that POA is the person who manages R1’s finances.
During a file review, LPA reviewed the Unusual Incident/Injury Reports faxed to the department, LPA did not observe any reports regarding R1 having feces in their mouth on 04/13/2026 or regarding being transferred to the Emergency Room on 04/17/2026.
During interviews with Staff S1-S7, were asked if staff meet the reporting requirements, informing the residents responsible party, physician, and/or Community Care Licensing (CCL) of unusual incidents and/or injury’s, seven (7) out of seven (7) stated yes incidents are reported to the responsible party or power of attorney, the physician, and CCL.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC9099 (FAS) - (06/04)

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