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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 01/11/2024
Date Signed: 02/07/2024 03:07:45 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/13/2023 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20231113122915
FACILITY NAME:GLEN PARK AT LONG BEACHFACILITY NUMBER:
198602134
ADMINISTRATOR:MICHAEL MENDOZAFACILITY TYPE:
740
ADDRESS:1046 E 4TH STTELEPHONE:
(562) 432-7468
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY:208CENSUS: 97DATE:
01/11/2024
UNANNOUNCEDTIME BEGAN:
11:59 AM
MET WITH:ADMINISTRATOR MICHAEL MENDOZATIME COMPLETED:
12:30 PM
ALLEGATION(S):
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9
Staff did not meet resident's showering needs.
Staff did not seek resident timely medical attention.
Staff did not ensure security of resident's personal belongings.
Staff gave an explanation of circumstances at the time of resident's death, different from what a doctor reported.
INVESTIGATION FINDINGS:
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THIS REPORT SUPERSEDES THE REPORT DATED 11/18/2023 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED
Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Glen Park at Long Beach on 11/16/2023 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.
Investigation consisted of the following: LPA Calderon interviewed Administrator Michael Mendoza A1, R1-R10, S1-S2. These interviews were conducted on 11/16/2023 and 02/07/2024. On 11/16/2023 LPA Calderon obtained and reviewed copies of the following: Shower log notes (date 11/13/2023), Incident reports (date 10/30/2023, 10/31/2023, 11/02/2023), St Mary’s email (date 11/14/2023), Personal Property Inventory (date 09/28/2023), Physician Report (dated 08/23/2023) for R1.
The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
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 4
Control Number 11-AS-20231113122915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
VISIT DATE: 01/11/2024
NARRATIVE
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Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “staff did not meet residents showering needs”, “staff did not seek resident timely medical attention”, “staff did not ensure security of residents personal belongings”, “staff gave an explanation of circumstance at the time of residents death different from wat a doctor reported” is found to be UNSUBSTANTIATED.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Michael Mendoza A1.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20231113122915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
VISIT DATE: 01/11/2024
NARRATIVE
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Regarding Allegation #3: Staff did not ensure security of resident’s personal belongings.

This complaint alleged that staff did not secure R11 purse. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that when R11 passes away on 11/14/2023 R11 personal belongings are collected and stored for safety. A1 states that R11 purse was moved to the office and never was missing or stolen. A1 states that a property log is taken of exactly what the staff collects for the resident’s room. LPA Calderon conducted an interview with S1-S2. 2 out of 2 staff state that when an R11 passes away staff collects the personal belongings of the resident, and a property log is kept for the facility records. 2 out of 2 staff state that R11 purse was never stolen or missing and was moved to the office for safety. LPA Calderon conducted an interview with R1-R11. 10 out of 11 residents state that none of their personal belongings have gone missing or been stolen while living at the facility. 10 out of 11 residents state that staff do make sure the facility is secure and safe. LPA Calderon could not interview R11 as R11 had passed away on 11/14/2023. Reviewed personal property inventory (date 09/28/2023). 12 items noted for R11 personal belongings. No mention of R11 purse found.

Regarding Allegation #4: Staff explained circumstances at the time of resident’s death, different from what a doctor reported.

This complaint alleged that staff gave explanation of R11 passing that was different than the hospital records. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that A1 was called to R11 room by S2. A1 states that R11 was found unresponsive in bed and CPR was performed until the fire department arrived. A1 states that R11 pulse was found, and R11 was transported to the hospital for evaluation. A1 states that that A1 called the R11 family and spoke to R11 son. A1 states that A1 advised R11 son that R11 had a heart attack and was transported to the hospital. A1 states that A1 confirmed a DNR with the hospital and that the hospital would not provide any extraordinary lifesaving procedures due to the DNR. LPA Calderon conducted an interview with S2. S2 states that R11 was found unresponsive, and CPR was performed. S2 states that R11 was transported to the hospital for evaluation. S2 states that the front office contacted R11s’ families and advised of R11 medical status. LPA Calderon conducted an interview with R1-R11. 10 out of 11 residents state that staff inform their families of any medical status or updates. LPA Calderon could not interview R11 as R11 had passed away on 11/14/2023. Reviewed email from A1 to St. Mary’s Hospital (date 11/14/2023). A1 was requesting more information on R11 passing.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20231113122915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
VISIT DATE: 01/11/2024
NARRATIVE
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Regarding Allegation #1: Staff did not meet resident’s showering needs. This complaint alleged that staff did not meet R11 showering needs. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that all residents can take a shower when they want to. A1 states that R11 can take a shower with no help from staff and just need to be reminded by staff when to take a shower. A1 states that the facility keeps a shower log for the residents that do not take a shower or need to be reminded. LPA Calderon conducted an interview with S1-S2. 2 out of 2 staff state that R11 could take a shower by themselves. 2 out of 2 staff state the R11 need to be reminded to take a shower. 2 out of 2 staff state that they cannot force a resident to take a bath or shower. 2 out of 2 staff state that the facility keeps a shower log for those residents that refuse or forget to take a shower weekly. LPA Calderon conducted an interview with R1-R11. 10 out of 11 residents state that they can take a shower when they want, and staff have never told them not to take a shower. LPA Calderon could not interview R11 as R11 had passed away on 11/14/2023. LPA Calderon reviewed physician report (date 08/23/2023) for R11. The report states that R11 were able to shower with no aid from staff. Reviewed shower logs (date 11/13/2023) for resident. Log notes suggest that R11 was reminded 2 times to take a shower and records suggest that R11 took a shower 7 days a week. Regarding Allegation #2: Staff did not seek resident timely medical attention. This complaint alleged that staff did not seek CPR timely on R11. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that on 11/02/2023 approximately 8 am S2 found R11 unresponsive in R11 bed. A1 states that S2 called A1 who came to R11 room. A1 states that S2 was performing CPR on R11. A1 states that they moved R11 to the floor where A1 continued CPR on R11. A1 states that 911 was called and A1 was able to find a pulse when the fire department arrived. A1 states that R11 was taken to the hospital and passed away on 11/14/2023. A1 states that R11 had a DNR and A1 and S2 only performed CPR on R11. A1 states that R11 was taken to the hospital and passed away from a heart attack. LPA Calderon conducted an interview with S2. S2 states that on 11/02/2023 around 8:15 am S2 found R11 unresponsive in R11 bed. S2 states S2 started CPR on R11 and called 911. S2 states that S2 called A1 who arrived minutes later. S2 states A1 and S2 moved R11 to the floor and A1 continued CPR and A1 found a pulse. S2 states that R11 was transported to the hospital for evaluation. A1 states that R11 passed away from a heart attack per hospital. LPA Calderon conducted an interview with R1-R11. 10 out of 11 residents state that when residents need medical attention staff provides timely medical services. LPA Calderon could not interview R11 as R11 had passed away on 11/14/2023. Reviewed incident report (date 11/02/2023) report states that S2 found R11 unresponsive in bed. S2 called 911 and helped A1 move R11 to the floor. S2 started CPR on R11 and A1 continued CPR on R11 until fire department arrived.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/11/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4