198602134-9-19-2023-11-AS-MVAO-CW3TN8-20230927145218

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 09/19/2023
Date Signed: 09/19/2023 02:36:12 PM

Unsubstantiated

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
04/28/2023 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230428122858

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: 89	DATE:	09/19/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Michael Mendoza, Administrator		TIME COMPLETED:	03:01 PM

ALLEGATION(S):

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Resident sustained injuries due to staff handling resident in a rough manner

INVESTIGATION FINDINGS:

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On 09/19/2023 Licensing Program Analyst (LPA) Mario Leon arrived at the above mentioned facility to conduct a subsequent complaint visit. LPA was met by Administrator, Michael Mendoza (S1) and explained the purpose of the visit.

The investigation consisted of the following:
On 05/03/2023 LPA toured the facility with Administrator Michael Mendoza (S1). LPA requested a resident roster, staff roster and copies of two resident's (R1-R2) service records which included: Physician’s Report, Appraisals and Medication Administration Records. LPA interviewed two (2) staff and one (1) resident.
On 09/19/2023 LPA toured the facility with S1 and interviewed six (6) additional residents, interviewed four (4) additional staff and reviewed 3 staff files.

The investigation revealed the following:

Report continues, see LIC9099C

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

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-20230428122858

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: 09/19/2023

NARRATIVE

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Regarding the allegation: Resident sustained injuries due to staff handling resident in a rough manner.
It has been alleged that one resident sustained a cut on their hand, the size of a nickel, while being moved. On 05/03/2023 LPA observed the cut on R1 and interviewed R1 regarding the allegation. LPA interviewed two (2) staff (S1-S2), one (1) which denied the allegation and 1 who denied the interview over the phone, S2.
On 09/19/2023 LPA re-interviewed S2, on-site. LPA interviewed three (3) additional staff members (S3-S5), all 3 out of 3 have denied the allegation. LPA interviewed 6 additional residents (R2-R7), five (5) out of six (6) residents denied the allegation. Overall, 5 out of seven (7) residents have denied the allegation. LPA reviewed 3 staff files, 3 out of 3 files contained adequate training records.

According to LPA's observations, interviews and record review conducted, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the above allegation is Unsubstatiated.

An exit interview was held with Administrator, Michael Mendoza, and a copy of this report was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2023

LIC9099 (FAS) - (06/04)

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