198602134-12-21-2022-11-AS-JHAD-CMZUVV-20230112145542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 12/21/2022
Date Signed: 12/21/2022 02:45:11 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
01/09/2022 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220109123431

FACILITY NAME:	GLEN PARK AT LONG BEACH		FACILITY NUMBER:	198602134
ADMINISTRATOR:	MELISSA FLORES		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:	12/21/2022
		UNANNOUNCED	TIME BEGAN:	09:34 AM
MET WITH:	Camille Crenshaw		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Personal Rights - Failure to follow Mitigation Plan.

INVESTIGATION FINDINGS:

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On 12/21/22 at 9:15 am, Licensing Program Analyst (LPA) Perry Scott and Licensing Program Manager Janae Hammond conducted a complaint visit to the above facility. We were met by administrator, Camille Crenshaw, and the purpose of the visit was explained. The investigation consisted of the following:
On 12/21/22 LPA and LPM interviewed administrator, Camille Crenshaw staff 1 (S1) and Staff 2-7 and residents 1-6. LPA and LPM obtained copies of resident/staff rosters, staff timecard, in service training logs for confidential information training, and COVID-19 training. LPA and LPM conducted a tour of the physical plant, which consisted of common areas, resident rooms, and storage areas.
The investigation revealed the following:
Allegation: Personal Rights - Failure to follow Mitigation Plan.
It is alleged that the facility staff did not have access to personal protection equipment (PPE) during a COVID outbreak, and the facility allowed COVID positive staff to work during an outbreak.
On 12/21/22 between 9:40 and 11:15am, LPA Scott and LPM Hammond interviewed facility staff 1-7.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

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-20220109123431

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: GLEN PARK AT LONG BEACH	FACILITY NUMBER: 198602134
	VISIT DATE: 12/21/2022

NARRATIVE

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The interviewed revealed 6 of 7 staff interviewed denied the allegation. And 1of 7 staff confirmed the allegation. The interview with staff #6 revealed that staff #6 tested positive for COVID-19 on 01/15/2022. And reported to work on 01/17/2022. And staff #6 retested on 01/17/2022 and received a negative result. During the interview S6 stated S6 was not asked to return home to isolate but rather S6 continued to work.

On 12/21/2022 between 12:15-1:00pm, LPA Scott and LPM Hammond interviewed residents 1-6. The interview revealed 6 of 6 residents denied the allegation.

On 12/21/2022 at 1:05pm a record review was conducted and revealed the following:
Facility staff has completed in service training related to COVID-19. A tour of the physical plant was conducted, and supplies of personal protection equipment were stored in the front office, med room, administrator’s office, and supply room adjacent to the front office. PPEs are accessible to staff in the storage room and the front office.

LPA Scott conducted an in-office file review of the facility file, provider information notices (PINS), and approved facility mitigation plan, facility COVID-19 line-list, and guidance from Long Beach Department of Public Health (DPH).

Based on interviews, observations, and records review there was in sufficient evidence to support the allegation. 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, and a copy of this report was given to administrator, Camille Crenshaw.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2022

LIC9099 (FAS) - (06/04)

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