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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 07/16/2026
Date Signed: 07/16/2026 05:40:47 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 BEACHFACILITY NUMBER:
198602134
ADMINISTRATOR:ACE HUYNHFACILITY TYPE:
740
ADDRESS:1046 E 4TH STTELEPHONE:
(562) 432-7468
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY:208CENSUS: 105DATE:
07/16/2026
UNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Ace HuynhTIME COMPLETED:
05:45 PM
ALLEGATION(S):
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Staff do not ensure resident medication records are properly managed
INVESTIGATION FINDINGS:
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On 07/16/2026, 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 conducted a medication review for eight (8) residents. During a subsequent visit on 07/15/2026, 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: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
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 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: 07/16/2026
NARRATIVE
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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.

An exit interview was conducted with Brenna Randolph, Business Office Manager, 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: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
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: 07/16/2026
NARRATIVE
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Allegation: Staff do not ensure medication records are properly managed
The allegation alleges that there was no incident report for a resident’s medication that was observed on their bed and not taken.
During the facility visit, LPA conducted an audit of ten (10) residents Centrally Stored Medications using the electronic Medication Administration Record (eMAR). During the review, LPA observed the following medications not signed off as taken or refused for Resident R1, R13-R21:

>Resient R1


-Divalproex Sod ER 500mg > not signed off on MAR 07/03/2026, no comments
-Donepezil HCL 5 MG Tables > not signed off on MAR 07/03/2026, no comments
-Mirtazapine 15mg > not signed off on MAR 07/03/2026, no comments
-Mirtazapine 7.5mg > not signed off on MAR 07/03/2026, no comments
-Atrovastain 20mg > not signed off on MAR 07/03/2026, no comments
-Busprione HCL 10mg > PM not signed off on MAR 07/02/2026, 07/05/2026, and 07/11/2026, no comments
-Quietapine Fumarate 25mg > PM not signed off on MAR on 07/03/2026, no comments.

>Resident R13


-Eliquis 5mg > not signed off AM on MAR 07/08/2026 and 07/10/2026, no comments
-Escitalopram 5mg > not signed off on MAR 07/08/2026 and 07/10/2026, no comments
-Potassium CL ER 20 Meq > not signed off on MAR 07/08/2026 and 07/10/2026, no comments
-Folic Acid 1mg> not signed off on MAR 07/08/2026 and 07/10/2026, no comments
-Hydralazine 50mg > not signed off on AM MAR 07/08/2026 and 07/10/2026, no comments
-Metoprolol Taritrate 25mg> not signed off on AM MAR 07/08/2026 and 07/10/2026, no comments
-Vitamin B-1 100mg> not signed off on MAR 07/08/2026 and 07/10/2026, no comments
-Vitamin B12 500mcg > not signed off on AM MAR 07/08/2026 and 07/10/2026, no comments

>Resident R14


-Asprin EC 81 mg > not signed off on AM MAR 07/08/2026, no comments
-Docusate Sodium 100mg > not signed off on AM MAR 07/08/2026, no comments
-Fluticasone Prop 50 mcg > not signed off on AM MAR 07/08/2026, no comments.
-Lactulose 10 gm/15ml > not signed off on AM MAR 07/08/2026, no comments.
-Pantoprazole SOD DR 40mg > not signed off on AM MAR 07/11/2026 and 07/12/2026, no comments.
-Potassium CL ER 20 MEQ > not signed off on AM MAR 07/08/2026, no comments.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC9099 (FAS) - (06/04)
Page: 3 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: 07/16/2026
NARRATIVE
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-Vitamin D3 2000 IU 50 MG >Not signed off on AM 07/11/2026.

> Resident R19


-Levothyroxine 50 MCG > Not signed off on AM 07/11/2026. No comments.

> Resident R20


- Aspirin 81 MG > Not signed off on AM 07/10/2026. No comments.
-Clopidogrel 75 MG > Not signed off on AM 07/10/2026. No comments.
-Famotidine 20 MG > Not signed off on AM 07/10/2026. No comments.
-Metoprolol Tartirate 50 MG > Not signed off on AM 07/10/2026. No comments.
- Naltrexone 50 MG > Not signed off on AM 07/11/2026 and 07/12/2026. No comments.
-Quetiapine Fumarate 100 MG > Not signed off on AM 07/10/2026. No comments.
-Vitamin B-12 1,000 Unit> Not signed off on AM 07/10/2026. No comments.
-Vitamin D3 5,000 Unit > Not signed off on AM 07/10/2026. No comments.

> Resident R21


-Atorvastatin 40 MG > Not signed off on PM 07/01/2026, 07/02/2026, and 07/03/2026. No comments.
-Divalproex SOD DR 125 mg > Not signed off on PM 07/02/2026, 07/05/2026, and 07/11/2026. No comments.
-Donepepezil HCL 5 MG > Not signed off on PM 07/3/2026. No comments.
-Memantine HCL 5 MG > Not signed off on PM 07/02/2026, 07/05/2026, and 07/11/2026. No comments.
-Quetiapine Fumarate 100 MG > Not signed off on PM 07/03/2026. No comments.
-Senna 8.6 MG > Not signed off on PM 07/02/2026, 07/05/2026, and 07/11/2026. No comments.

During interviews with Staff S1-S7, were asked if staff keep accurate records of residents medications and doses taken, seven (7) out of seven (7) stated yes, staff keep accurate records of residents medications taken.

During interview's with Residents R1-R12, were asked if they feel staff properly manage their medication records, twelve (12) out of twelve (12) stated yes, they believe staff properly manage their medication records.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/16/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/30/2026
Section Cited
CCR
87505(a)
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87506 Resident Records (a)The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.
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Administrator will develop a plan to ensure that medication administration records are checked frequently to avoid discrepancies. Administrator will submit plan to LPA by POC due date.
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Based on observations, interviews, and record review Staff failed to ensure medications were documented as administered or refused for R1, R13, R14, R16-R21, This poses an immediate health and safety risk to residents in care.
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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: 07/16/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC9099 (FAS) - (06/04)
Page: 2 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: 07/16/2026
NARRATIVE
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-Quetiapine Fumarate 50mg > not signed off on PM MAR 07/08/2026, no comments.
-Refresh Tears 0.5% drops 1 OP > not signed off on AM MAR 07/08/2026, no comments.
-Resperidone 0.5 MG > Not signed off on AM MAR 07/08/2026, no comments

>Resident R16


-Amlodipine Besylate 5 MG> not signed off on AM MAR 07/07/2026 and 07/10/2026, no comments.
-Ammonium Lactate 12% Cream> not signed off on AM MAR 07/07/2026 and 07/10/2026, no comments.
-Asprin EC 81 MG > not signed off on AM MAR 07/07/2026 and 07/10/2026, no comments.
-Clopidogrel 75 MG > not signed off on AM MAR 07/07/2026 and 07/10/2026, no comments.
-Escitalopram 10 MG > not signed off on AM MAR 07/07/2026 and 07/10/2026, no comments.
-Famotidine 20 MG > not signed off on AM and PM MAR for 07/07/2026 and not signed off on AM 07/10/2026, no comments.
-Geri-Mucil Powder 1 PO > not signed off on AM MAR 07/07/2026 and 07/10/2026, no comments.
-Glucosamine Daily Complex T 1 PO > not signed off on AM MAR 07/07/2026 and 07/10/2026, no comments.
-Januvia 100 MG - not signed off on AM MAR 07/07/2026 and 07/10/2026, no comments.
-Metformin 500MG > not signed off on AM and PM MAR 07/07/2026 and not signed off on AM 07/10/2026, no comments.
-Sitagliptin Phos 100 MG > not signed off on AM MAR 07/07/2026 and 07/10/2026, no comments.
-Tamsulosin 0.4 MG > not signed off on AM MAR 07/07/2026 and 07/10/2026, no comments.

>Resident R17


-Aripiprazoles 5 MG > 07/11/2026 pill in packet, not signed on MAR, and no comment. 07/12/2026 pill in packet, not signed on MAR, and no comment. 07/13/2026 removed from packet, not signed off on MAR, and no comment. 07/14/2026 removed from packet, not signed off on MAR, and no comment.
-Hydrocodone-Acet 5-325 > Not signed off on eMAR for 07/08/2026 and 07/11/2026
-Lidocaine 4% Patch > Not signed off on MAR for 07/11/2026. No Comment.
-Pantoprazole SOD DR 40 MG > Not signed off on 07/11/2026 and 07/12/2026.
-Vitamin C 1,000 MG > Not signed off on MAR on 07/11/2026, No comment.
-Vitamin D3 50 MG > Not signed off on MAR on 07/11/2026, No comment.
> Resident R18
-Oxybutynin 5 MG - Not signed off on 07/11/2026 12pm. No comments.
-Pantoprazole SOD DR 40 MG > Not signed off on AM 07/11/2026 and 07/12/2026. No comments.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 07/16/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/16/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 6