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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 10/25/2023
Date Signed: 11/07/2023 02:23:12 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
03/15/2023 and conducted by Evaluator Elizabeth Ceniceros
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230315135635
FACILITY NAME:GLEN PARK AT LONG BEACHFACILITY NUMBER:
198602134
ADMINISTRATOR:CAMILLE CRENSHAWFACILITY TYPE:
740
ADDRESS:1046 E 4TH STTELEPHONE:
(562) 432-7468
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY:208CENSUS: 97DATE:
10/25/2023
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH: Staff #1: Office Manager (S1: Tyshima Bonner)TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff are allowing residents with prohibited health conditions to reside in the facility.
Staff are not preventing residents from sustaining skin tears while in care.
Staff are yelling at the residents.
Staff are abusing the residents while in care.
Staff denied residents the right to get a Covid-19 Vaccine.
Staff are stealing money and personal belongings from residents.
Staff are stealing residents medications.
Staff are denying residents food.
Staff are not treating residents with dignity.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA)/Retired Annuitant (RA) Elizabeth Ceniceros made an unannounced visit to the facility and was greeted by Staff #1 (S1: Tyshima Bonner, Office Manager); as Administrator (A1: Michael Mendoza) was unavailable. LPA/RA conducted a risk assessment prior to entering facility. S1 informed LPA/RA that the facility has no COVID cases nor do the residents nor staff have symptoms. The purpose for today’s visit is to conduct a subsequent visit to deliver the findings pertaining to the above-mentioned allegations.

An initial 10-Day visit was conducted by LPA Martessa Brown on 03/23/23 who was met by the Administrator. During today’s visit, LPA/RA re-interviewed the Administrator (via landline), Staff #1 - Staff #5 (S1-S5) and Residents #1 - Resident #8 (R1-R8). LPA/RA toured the facility's physical plant for health and safety purposes of residents in care. LPA/RA reviewed the following documents: Admission Agreements, Physician’s Reports, Resident Appraisals, Medication Administration Records (October 2023), COVID-19 Vaccine cards, and Personal Property Inventory for Resident #9 - Resident #12 (R9-R12). LPA/RA
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elizabeth CenicerosTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
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 5
Control Number 11-AS-20230315135635
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: 10/25/2023
NARRATIVE
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reviewed the Trust Account/P & I Ledgers (March 2023 & October 2023), Incident Reports (02/21/23 – 03/01/23), Staff In-service Training Records, Monthly Menu (October 2023), Facility Staff (S1-S5) and Residents (R9-R12) files, Facility Staff and Residents' rosters (dated 02/23/22 & 10/06/23). LPA/RA toured the facility's physical plant: memory care unit, medication room, and commercial-size kitchen. LPA/RA observed the security monitors and camera system and delayed egress doors.

Regarding Allegation #1: this investigation revealed that the facility is a vendor of the Harbor Regional Center (HRC) and participant of the Assisted-Living Waiver program. Residents who require 24/7 level of care reside in the facility’s secured unit on the 2nd floor that requires a key-card system. Interviews conducted of seven (7) staff corroborated that the facility does not have residents with a prohibited health condition. Executive Director stated that whenever a resident requires a higher level of care, facility staff will call 9-1-1 or non-emergency ambulance. If the facility receives a call regarding accepting/returning a resident with a prohibited health condition, they are advised that the facility is not a medical facility. Interviews conducted of eight (8) residents, corroborated that they did not have a prohibited health condition nor had they known of residents living in the facility with a prohibited health condition.

Based on the evidence gathered, interviews conducted, and records reviewed, 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 of LEVEL OF CARE: Staff are allowing residents with prohibited health conditions to reside in the facility is found to be UNSUBSTANTIATED.

Regarding Allegation #2: this investigation revealed based on interviews conducted of seven (7) facility staff who corroborated that whenever a resident has sustained a skin tear, the med techs will provide first-aid. Interviews conducted of eight (8) residents corroborated that they are provided with first aid by the med techs whenever they have sustained a skin tear. LPA/RA reviewed facility staff in-service training record on the topic of How to Manage Elderly Skin, Skin Integrity, and First Aid.

Based on the evidence gathered, interviews conducted, and records reviewed, 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 of NEGLECT/LACK OF SUPERVISION: Staff are not preventing residents from sustaining skin tears while in care is found to be UNSUBSTANTIATED.

Regarding Allegation #3: this investigation revealed based on interviews conducted of seven (7) facility staff members corroborated that often a resident cannot hear so facility staff often has to raise their voice in

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elizabeth CenicerosTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20230315135635
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: 10/25/2023
NARRATIVE
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an effort to communicate to the resident(s). There has been no complaints made to facility staff from residents regarding facility staff yelling at them. Interviews conducted of eight (8) of the residents corroborated that they have not been yelled at by a facility staff member nor observed other residents in care being yelled at by facility staff. LPA/RA reviewed the facility staff rosters (dated 02/23/22 & 10/06/23) that did not document a staff member by the first name of “Brenda” or “Marina” or “April”. LPA/RA reviewed facility staff in-service training records on the topic of Mandated Reporting.

Based on the evidence gathered, interviews conducted, and records reviewed, 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 of PERSONAL RIGHTS: Staff are yelling at the residents is found to be UNSUBSTANTIATED.

Regarding Allegation #4: this investigation revealed a tour of the facility’s physical plant was conducted upon arrival to ensure the health and safety of residents in care. Interviews conducted of seven (7) facility staff members corroborated that there has not been reports of abuse from residents or their representatives (ALW, PACE, HRC) or responsible person(s). Interviews conducted of eight (8) residents corroborated that they have not been abused by facility staff nor have they observed a resident in care being abused by a facility staff member. LPA/RA reviewed the facility staff rosters (dated 02/23/22 & 10/06/23) that did not document a staff member by the first name of “Brenda” or “Marina” or "April". LPA/RA reviewed facility staff in-service training records on the topics of Non-violent Crisis Intervention and Mandated Reporting.

Based on the evidence gathered, interviews conducted, and records reviewed, 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 of PERSONAL RIGHTS: Staff are abusing the residents while in care is found to be UNSUBSTANTIATED.

Regarding Allegation #5: this investigation revealed based on interviews conducted of seven (7) facility staff that 95 of the 97 residents in care have received both of their COVID-19 vaccines. Interviews conducted of eight (8) residents corroborated that they were not denied and have received both of their COVID-19 vaccinations. Administrator stated that residents from the PACE program received their vaccines through PACE and all other residents in care either received their vaccinations from the facility’s in-house doctor or CVS. LPA/RA observed facility’s Incident Reports to CCLD regarding COVID-19, staff in-service training record on the topic of Reducing Risk Keeping Safe & Preventing Spread, and (R9-R12) COVID-19 vaccination cards.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elizabeth CenicerosTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20230315135635
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: 10/25/2023
NARRATIVE
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Based on the evidence gathered, interviews conducted, and records reviewed, 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 of PERSONAL RIGHTS: Staff denied residents the right to get a Covid-19 Vaccine is found to be UNSUBSTANTIATED.

Regarding Allegation #6: this investigation revealed based on interviews conducted of seven (7) staff members that there has not been complaints from residents in care that staff stole their money or personal belongings. Interviews conducted of eight (8) residents in care corroborated that they have not had money or personal belongings stolen by facility staff. Administrator stated that the facility maintains a trust account for every resident in care. LPA/RA reviewed facility’s Trust Account Ledgers (March 2023 and October 2023) for 45 residents.

Based on the evidence gathered, interviews conducted, and records reviewed, 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 of PERSONAL RIGHTS Staff are stealing money and personal belongings from residents is found to be UNSUBSTANTIATED.

Regarding Allegation #7: this investigation revealed based on interviews conducted of A1, A2, S1, and S2 that once the med techs administer residents’ medication(s), the med tech will initial the MAR. Interviews conducted of eight (8) residents corroborated that the med techs do administer their medications and have not been known to have missed medication(s). LPA/RA toured the medication room for observation of the medications and review of the medication administration records for R9-R12 that had been administered during the month of October 2023. LPA/RA reviewed facility staff in-service training on the topic of medication administration for Staff #2.

Based on the evidence gathered, interviews conducted, and records reviewed, 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 of MEDICATIONS: Staff are stealing residents’ medications is found to be UNSUBSTANTIATED.

Regarding Allegation #8: this investigation revealed based on interviews conducted of seven (7) staff members corroborated that they have not received complaints from residents that they were denied food. Staff #4 (Kitchen Aide/Server) indicated that if a resident should miss their mealtime (breakfast, lunch and/or dinner) there is always optional meals to select. Interviews conducted of eight (8) residents corroborated

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elizabeth CenicerosTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20230315135635
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: 10/25/2023
NARRATIVE
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that they have not been denied a meal nor have they heard of a resident denied a meal. LPA/RA toured the commercial-size kitchen and observed a sufficient food supply of perishables and non-perishables including the posted monthly menu.

Based on the evidence gathered, interviews conducted, and records reviewed, 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 of FOOD SERVICE: Staff are denying residents food is found to be UNSUBSTANTIATED.

Regarding Allegation #9: this investigation revealed based on interviews conducted of seven (7) staff members corroborated that they have not received a complaint from residents in care that facility staff are not treating them with respect. Interviews conducted of eight (8) residents corroborated that facility staff are compliant and compassionate to their needs and have not been intimidated or bullied or threatened by a facility staff member. LPA/RA reviewed the facility staff rosters (dated 02/23/22 & 10/06/23) that did not document a staff member by the first name of “Brenda” or “Marina” or "April". LPA/RA reviewed facility staff in-service training record on the topics of Non-violent Crisis Intervention, Personal Rights, and Mandated Reporting.

Based on the evidence gathered, interviews conducted, and records reviewed, 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 of PERSONAL RIGHTS: Staff are not treating residents with dignity is found to be UNSUBSTANTIATED.

An exit interview has been conducted and a copy of the Complaint Report provided to Staff #1 (Tyshima Bonner, Office Manager).

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elizabeth CenicerosTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 10/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5