198602134-5-17-2023-11-AS-JHAD-CSZN6K-20230621101117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 05/16/2023
Date Signed: 05/17/2023 06:43:11 AM

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
05/09/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230509075848

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:	05/16/2023
		UNANNOUNCED	TIME BEGAN:	10:06 AM
MET WITH:	Melissa Flores & Michael Mendoza		TIME COMPLETED:	05:47 PM

ALLEGATION(S):

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Facility staff intimidated a resident who reported.
Facility did not have qualified staff on duty.

INVESTIGATION FINDINGS:

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On 05/16/23 Licensing Program Analyst (LPA) Ernand Dabuet made an unannounced 10-day visit at this facility to initiate an investigation regarding allegations listed above. LPA spoke with Melissa Flores Quality Assurance Director that there are no Covid-19 cases. LPA met with Michael Medoza Executive Director and Flores and explained the purpose of today's visit is to collect information regarding the allegations.

The investigation consisted of the following: LPA toured the facility with Michael Mendoza and did not see any health and safety concerns. LPA interviewed the Executive Director and staff #2-#4 (S2-S4). Interviews with residents #1-#7 (R1-R7). A review of staff and resident roaster, resident medication logs and progress notes, staff training and other documents pertinent or associated with this complaint.

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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-20230509075848

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: 05/16/2023

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility staff intimidated a resident who reported.
It is alleged the facility staff intimated a resident who reported. The complainant did not offer additional information on this matter. The complainant did not offer what happened or who was involved. There were no dates or times when the incident occurred. The Department interviewed residents #1-#7 (R1-R7) and were complimentary of the staff. (R1-R7) acknowledged the facility with the new management on board, that problems may exist through the transition phases. However, (R1-R7) recognized there are many benefits to change in management. These benefits included improved communication with residents and staff. (R1-R7) stated they were treated with respect and no staff had used force intimation acts on residents. Interviews with staff #1-#4 (S1-S4) denied this accusation. (S1-S4) reported there is no act or course of conduct directed at any individual to cause that person to fear or apprehend fear. (S2) stated any staff who participates in this act is considered harassment and the company has a zero-tolerance policy for this aggressive behavior. Based on limited information from the complainant and interviews conducted, there is no evidence to support the allegation mentioned above.

Allegation: Facility did not have qualified staff on duty.
It is alleged the facility did not have qualified staff working. The complainant described the facility had no medication technician staff from 11 pm through 7 am on 5/05/23 and 05/06/23. The complainant did not offer further information and did not present the names of individuals involved. Residents #5-#7 (R5-R7) who specifically require assistance with medications between 11 p.m. through 7 a.m. claim to have no problems and verified that two (2) staff employees were during those days. (R5-R7) reported receiving their PRN (pro re nata) on time at midnight and did not require an additional dose of medication until morning. A review of the Medication Administration Records (MAR) confirmed that (R5-R7) received their PRN medications. Prescription medications were disbursed without any issues or concerns to residents #1-#6 (R1-R6). (S1-S4) reported the staff are fully trained on medications. According to (S1-S2), staff are crossed trained and have completed the basic medication training courses. The Department reviewed staff training records and personnel report found them to be accurate and complete. (S1-S2) stated in case of a staffing crisis, the staff are cross trained to cover caregivers and medication technicians. (S2) reported that in addition to cross-training staff, healthcare staffing agencies will temporarily staff the facility. Based on information gathered, there is no evidence to corroborate the allegation mentioned above.
This report serves as an amendment to clarify #27. It does not supersedes the complaint investigation findings reflected on report created 05/16/23. (Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230509075848

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: 05/16/2023

NARRATIVE

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Based on the information gathered, an inspection of the facility, observation, and interviews conducted, the Department found no evidence to support the allegations mentioned in this complaint.

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.

No deficiencies were cited during this visit.

An exit interview was conducted with Michael Mendoza and a copy of the report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

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