198602134-10-5-2023-11-AS-JHAD-CWW29N-20231023171213

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 09/29/2023
Date Signed: 10/05/2023 09:55:15 AM

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
04/03/2023 and conducted by Evaluator Lizeth Villegas

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230403154927

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: 91	DATE:	09/29/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Executive Director Michael Mendoza		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Residents are being sexually abused while in care
Residents are being physically abused while in care
Staff mismanage residents’ medication
Residents are being financially abused while in care
Residents are being neglected while in care
Residents’ rights are being violated
Staff failed to provide adequate food service
Residents are being confined to their rooms

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 09/29/23 Licensing program analyst (LPA) Lizeth Villegas and Licensing program manager (LPM) Janae Hammond conduced a subsequent complaint visit to render investigation findings. During todays visit LPA and LPM met with Executive Director Michael Mendoza and the purpose of todays visit was explained.

The investigation consisted of the following:
On 04/04/23 LPA Gibbs obtained copies of the following documents: Resident Roster, Staff Roster, Staff training in Medication Administration, Staff training in Personal Rights, Menu, Dietician/Nutritionist review of menu report, Assisted Living Waiver Resident list, any resident financial records for money entrusted to the facility and Staff Record (Files to be emailed).

On 09/29/23 LPA and LPM conducted interviews with Staff #1-9, interviews with residents # 1-9, obtained copies of staff and resident rosters, P&I ledgers and receipts and conducted review of 9 medication administratoin records.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

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 3

Control Number 11-AS-20230403154927

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: 09/29/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:

Allegation:Residents are being sexually abused while in care

It is being alleged residents are being sexually abused while in care, there was no specific resident identified, no date nor time indicated and no specific details provided. On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation and reported being unaware of any resident being sexually abused. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation. LPA conducted file review and there were no incident reports on file for the above allegation.

Allegation: Residents are being physically abused while in care

It is being alleged residents are being physically abused while in care, there was no specific resident identified, no date nor time indicated and no specific details provided. On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation and reported being unaware of any resident being physically abused while in care. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation. LPA conducted file review and there were no incident reports on file for the above allegation.

Allegation: Staff mismanage residents’ medication

On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation. 2 of 9 staff interviewed reported being responsible for conducting quality assurance and reported not findings and discrepancies. On 09/29/23 LPA and LPM interviewed R1-9, 8 out of 9 residents denied the allegation. 1 of 9 residents interviewed reported having 1 pill missing and error was fixed. On 09/29/23 LPA conducted review of 9 medication administration records and did not observe any discrepancies. On 04/04/23 LPA Gibbs reviewed staff records and obtained a copy of medication training for staff that administer medications.

Allegation: Residents are being financially abused while in care

On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation of being financially abused. 4 out of 9 residents interviewed reported family or self being financially responsible for finances, 5 out of 9 residents interviewed reported the facility is responsible for their finances. On 04/04/23 and 09/29/23 LPA reviewed P&I ledgers and receipts and did not observe any discrepancies.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230403154927

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: 09/29/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Residents are being neglected while in care

It is being alleged residents are being neglected while in care, there was no specific resident identified, no date nor time indicated and no specific details provided. On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation.

Allegation: Residents’ rights are being violated

It is being alleged residents rights are being violated, no specific or additional details provided. On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation.

Allegation: Staff failed to provide adequate food service

It is being alleged facility staff is denying residents food. On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation. S1-9 stated dinning room is always open for residents to obtain food whenever they like. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation and reported receiving meals 3 times a day and snacks 2 times a day. On 04/04/23 LPA Gibbs obtained copies of Menu, Dietician/Nutritionist review of menu report. On 04/04/23 LPA Gibbs conducted tour of facility kitchen and inspected food supply, LPA observed food to be adequately stocked at the time of visit.

Allegation: Residents are being confined to their rooms

On 09/29/23 LPA and LPM interviewed S1-9, 9 out of 9 staff denied the above allegation. 9 of 9 staff interviewed reported residents were asked to stay in their rooms during Covid per policy. On 09/29/23 LPA and LPM interviewed R1-9, 9 out of 9 residents denied the allegation. 3 of 9 residents interviewed reported residents were asked to stay in their rooms during covid.

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.

Exit interview conducted with Executive Director Michael Mendoza, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/29/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3