198602134-12-18-2023-11-AS-EMAZ-CZKSZQ-20240117131932

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 12/18/2023
Date Signed: 12/18/2023 03:01:31 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
12/11/2023 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20231211112444

FACILITY NAME:	GLEN PARK AT LONG BEACH		FACILITY NUMBER:	198602134
ADMINISTRATOR:	MICHAEL MENDOZA		FACILITY TYPE:	740
ADDRESS:	1046 E 4TH ST		TELEPHONE:	(562) 432-7468
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	208	CENSUS: 100	DATE:	12/18/2023
		UNANNOUNCED	TIME BEGAN:	09:24 AM
MET WITH:	ADMINISTRATOR MICHAEL MENDOZA		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff handled resident in a rough manner.
Staff does not respond to resident’s call for assistance.
Staff does not serve nutritious meals.
Staff served resident expired milk

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Glen Park at Long Beach on 12/18/2023 and was greeted by Administrator Michael Mendoza (A1). LPA Calderon spoke to A1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

During this investigation, LPA Calderon interviewed A1, S1-S3, R1-R9. These interviews were conducted on 12/18/2023. On 12/18/2023 LPA Calderon obtained and reviewed copies of the following: PACE level of care determination (date 09/01/2023), Incident report (date 12/08/2023), Meal Plan (date 12/1/2023 to 12/31/2023). On 12/18/2023 LPA Calderon toured the kitchen.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

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-20231211112444

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: 12/18/2023

NARRATIVE

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Regarding Allegation #1: Staff handled resident in a rough manner.

This complaint alleged that S1 handled R1 in a ruff manner injuring R1 left leg and arm area. LPA Calderon conducted an interview with A1. A1 states that S1 has been working for the facility for 1 year and helps care for residents. A1 states that S1 was pushing R1 wheelchair who was leaving the facility for the morning. A1 states that that R1 has an old wheelchair and as S1 was pushing R1 chair R1 foot got caught in the front wheelchair wheel and R1 left foot was not injured. A1 states that A1 advised R1 social worker of the situation and that R1 was not injured. A1 states that the incident was an accident and not abuse on S1 part. LPA Calderon conducted an interview with S1 who states that S1 does not remember what happened to R1 foot. LPA Calderon conducted an interview with S3 who states that S1 is a professional and has no history of abuse and the incident was an accident. LPA Calderon conducted an interview with R1-R9. R1 states that S1 was in a hurry to get R1 into the van and R1 foot got caught in the front wheel of the chair. R1 states that this is the second time S1 has rushed and injured R1 body. R1 does not remember the date, but that the incident happened in R1 room and R1 left arm was injured. 8 out of 8 residents states no issues with service provided and staff have never been unprofessional.

Regarding Allegation #2: Staff does not respond to residents call for assistance.

This complaint alleged that staff does not respond to R1 call for assistance. LPA Calderon conducted an interview with A1. A1 states that the facility does not keep call button logs, but that staff do respond to resident request for services within 10 to 15 minutes depending on the time of the call. A1 states that staff do not take 45 minutes to respond as R1 claims. LPA Calderon conducted an interview with S3. S3 states that depending on when the resident pushes the service button it may take 10 minutes or 15 minutes for staff to respond for service, but staff do not take 45 minutes to respond for residents’ services. LPA Calderon conducted an interview with R1-R9. R1 states that R1 pushed the call button and staff took 45 minutes to respond. R1 states that R1 yelled out from the bathroom area with no response from staff. R1 states that R1 roommate R7 had to help R1 into and out of the bathroom. 8 out of 8 residents state that staff takes 10 to 15 minutes to respond when the call button is pushed. R7 states that R7 does not remember how long it took staff to arrive for service and R7 had nothing to say on the incident.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 11-AS-20231211112444

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: 12/18/2023

NARRATIVE

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Regarding Allegation #3: Staff does not serve nutritious meals.

This complaint alleged that staff do not serve R1 nutritious meals. LPA Calderon conducted an interview with A1. A1 states that A1 has 2 cook who follow a meal plan and serve nutritious meals 3 times per day, 7 days a week. A1 states that not all resident love the food served but A1 states that A1 cooks speak to residents and get feed back on the food served. LPA Calderon conducted an interview with S2. S2 states that S2 has been a cook for over 8 years and a cook for the facility for 1 year. S2 states that S2 follows a meal plan and serves nutritious meals every day. S2 states that S2 has 3 dining staff taste S2 food prior to serving to make sure the food is nutritious and taste good. S2 states that most resident love S2 food but not all. LPA Calderon conducted an interview with R1-R9. R1 states that staff refuses to serve R1 lunch when R1 is out of the facility. R1 states that the food is not good and not nutritious. 8 out of 8 residents state that the food is ok and 8 out of 8 residents have no issues with the food served. Reviewed facility meal plan (date 12/01/2023 to 12/31/2023), meal plan appears to be balanced and meets the needs of residents.

Regarding Allegation #4: Staff served R1 expired milk.

This complaint alleged that staff served R1 expired milk. LPA Calderon conducted an interview with A1. A1 states that no dining staff would or does serve expired milk to residents in care. A1 states that dining staff check for expired foods and rotate the food stores to make sure no expired food is served. LPA Calderon conducted an interview with S2. S2 states that S2 has been the facility cook for 1 year. S2 states that S2 checks daily food stores and makes sure to rotate foods. S2 states that no dining staff would serve expired food or milk. S2 states that staff taste the milk prior to service and makes sure the milk taste good and is not expired. LPA Calderon conducted an interview with R1-R9. R1 states that R1 eats cold cereal in the morning and the milk served is off and does not taste good. 8 out of 8 residents state to have no issues with the milk served and the milk taste fine. LPA Calderon toured the kitchen and inspected the 1-gallon milk bottles. LPA Calderon could not find any expired milk.

Based on interviews, observations and supporting documents. The preponderance of evidence standard has NOT been met; therefore, the allegation of “Staff handled resident in a rough manner” “Staff does not respond to residents call for assistance”, “Staff does not serve nutritious meals”, “Staff served resident expired milk” is found to be UNSUBSTANTIATED.

A face-to-face meeting was conducted with Administrator Michael Mendoza and a hard copy was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2023

LIC9099 (FAS) - (06/04)

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