198602134-1-31-2023-11-AS-JHAD-CSTUV9-20230615155447

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 01/31/2023
Date Signed: 01/31/2023 05:48:44 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
09/15/2022 and conducted by Evaluator Jeremiah Randle

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220915094537

FACILITY NAME:	GLEN PARK AT LONG BEACH		FACILITY NUMBER:	198602134
ADMINISTRATOR:	CAMILLE CRENSHAW		FACILITY TYPE:	740
ADDRESS:	1046 E 4TH ST		TELEPHONE:	(562) 432-7468
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	208	CENSUS: 76	DATE:	01/31/2023
		UNANNOUNCED	TIME BEGAN:	10:37 AM
MET WITH:	Camille Crenshaw Administrator		TIME COMPLETED:	05:43 PM

ALLEGATION(S):

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Staff did not inform responsible party of change in resident's condition
Staff did not assist resident with obtaining medical care
Staff did not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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On 1/31/2023 Licensing Program Analyst (LPA) Jeremiah Randle conducted an unannounced subsequent complaint investigation at the facility listed above. LPA arrived at facility and was greeted by Administrator Camille Crenshaw. LPA explained the purposed of the visit is to deliver findings on the allegations listed above.

The investigation consisted of the following:

LPA Randle toured facility grounds, LPA requested pertinent documents pertaining to the investigation. The following documents were gathered: Staff and Client Rosters, entire file for resident (R1) including MARS and any other pertinent documentation regarding R1 such as special incident reports. LPA reviewed facility files and interviewed staff (S1-S8), Resident (R1) was not interviewed R1 never returned to the facility from hospitalization, further R1’s medical condition would likely not yield comprehensible information.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

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-20220915094537

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: 01/31/2023

NARRATIVE

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Con't
On 1/31/2023 LPA Randle interviewed or attempted interviews with residents (R2-R9). LPA requested, received, and reviewed the following information: entire file of R1, Staff roster, Resident roster, and other documents relevant to the investigation.

Investigation Revealed the following.

Allegation: Staff did not inform responsible party of change in resident's condition

The complainant alleges Staff did not inform responsible party of change in resident's condition. LPA interviewed Administrator Camille Crenshaw (S1) denied the allegation. Administrator S1 added that R1’s responsible party has a POA and all medical decisions are approved by POA. Per Assistant Administrator (S8) POA in fact was involved directly in decisions regarding resident’s R1 condition. Per S8 R1’s POA was involved in medical decision regarding R1’s change in condition along with PCP. LPA interviewed residents (R2-R7) regarding the allegation Staff did not inform responsible party of change in resident's condition. Residents interviewed all stated (R2-R9) they had no problem with staff communicating their change of condition to their responsible party. LPA interviewed staff (S1-S8) regarding allegation all stated there were no delays in communicating to staff that informs responsible parties of changes to residents.

Based on information gathered, the department did not find sufficient evidence to support allegation " Staff did not inform responsible party of change in resident's condition

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20220915094537

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: 01/31/2023

NARRATIVE

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Allegation: Staff did not assist resident with obtaining medical care

The complainant alleges Staff did not assist resident with obtaining medical care. LPA interviewed Administrator Camille Crenshaw (S1) denied the allegation, S1 stated that facility staff and (S1) noticed R1’s gait therefore S1 provided a 1 on 1 to R1 for safety of fall risk. R1 was transported to the hospital for evaluation. LPA interviewed staff (S1-S8) all staff stated, residents are assisted with obtaining medical care when needed or asked, no one is denied. Residents (R1-R9) that were interviewed by LPA residents stated staff attends to residents in a timely manner when they call for any reason. Of the residents interviewed by LPA all had no complaints and affirmed they like living at the facility

Based on information gathered, the department did not find sufficient evidence to support allegation " Staff did not assist resident with obtaining medical care

Allegation: Licensee did not safeguard resident personal belongings.

The complainant alleges facility did not safeguard resident’s personal belongings. LPA interviewed Administrator Camille Crenshaw (S1) denied the allegation. LPA reviewed the property list of resident (R1) regarding the allegation. LPA observed the signature of R1's POA confirming all of R1’s property was returned. LPA interviewed (R2-R7) and asked if they had any property stolen or missing items those interviewed R2-R9 stated in the facility they feel safe and the facility keeps their property safe. LPA interviewed staff (S1-S8) regarding allegation, S1-S8 had not been made aware of any personal property or items missing and not found.

Based on information gathered, the department did not find sufficient evidence to support allegation " Licensee did not safeguard resident personal possessions.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20220915094537

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: 01/31/2023

NARRATIVE

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The Department’s investigation consisted of an inspection of the facility, observation, analysis of facility records and interviews conducted and found No evidence to support the allegations:

Staff did not inform responsible party of change in resident's condition

Staff did not assist resident with obtaining medical care

Licensee did not safeguard resident personal belongings.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted with Administrator Camille Crenshaw and a hard copy was provided.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: (323) 213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2023

LIC9099 (FAS) - (06/04)

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