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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 01/11/2024
Date Signed: 01/11/2024 12:35:24 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
01/02/2024 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20240102083125
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:
09:11 AM
MET WITH:ADMINISTRATOR MICHAEL MENDOZATIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not assist resident withing obtaining care.
Staff do not answer resident's call button in a timely manner
Staff speaks to resident in an inappropriate manner
Staff did not allow resident to possess personal belonging
Staff do not assist resident with showering
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Glen Park at Long Beach on 01/11/2024 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-R8, S1-S3. This interview was conducted on 01/10/2024. On 01/10/2024 LPA Calderon obtained and reviewed copies of the following: Physician Report (dated 10/10/2023), Shower logs (date 12/22/2023), Front desk logs (date 12/24/2023) for R1.

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
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 6
Control Number 11-AS-20240102083125
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 assist resident with obtaining care.

This complaint alleged that staff did not help R1 after falling in room and did not supply pain medication. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that there is no incident report for R1 falling on 12/24/2023. A1 states that A1 checked with A1 staff and no one knew of any unwitnessed fall from R1. A1 states that if R1 had advised staff of a fall, A1 staff would have called 911 and taken R1 to the hospital for evaluation. A1 states that if R1 had pain from the fall and requested Tylenol A1 staff would have given R1 the medication as the Tylenol is on R1 medication list. LPA Calderon conducted an interview with S1-S3. 3 out of 3 staff state to have no record of R1 falling and hitting R1 head on the bathroom doorknob on 12/24/2023. 3 out of 3 staff state they could not find any incident report for 12/24/2023 regarding R1 falling. 3 out of 3 staff state that if R1 had requested Tylenol for pain that the LVN would have given R1 the medication. LPA Calderon conducted an interview with R1-R8. R1 states that on 12/24/2023 R1 lost R1 balance and hit R1 head on the bathroom doorknob. R1 states that R1 got off the floor under R1’s own power and no staff came to help R1. R1 states that R1 asked for Tylenol for pain and staff would not give R1 the medication for pain. 7 out of 7 residents state that staff does take care of their medical needs and if they request medication staff takes care of their medication needs. Reviewed physician report (date 10/10/2023). R1 medication list lists Tylenol extra strength, dispensed 09/18/2023, 1 to 2 tablets for pain.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
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: 6 of 6
Control Number 11-AS-20240102083125
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 #2: Staff do not answer residents call button in a timely manner.

This complaint alleged that staff do not answer the R1 call button in a timely manner. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that A1 has no record of R1 falling on 12/24/2023. A1 states that if R1 had fallen and hit R1 head on the bathroom doorknob 911 would have been called and R1 would have been taken to the hospital for evaluation. A1 states that if R1 had pushed the call button staff would have responded to R1 room within minutes. A1 states that the facility does not keep call log records for residents, but A1 checked the front desk log notes for 12/24/2023 and there is no record of a call or button pushed by R1. A1 states that there is no way staff would take 30 minutes to respond to a call from any resident. LPA Calderon conducted an interview with S1-S3. 3 out of 3 staff state that they have no record of R1 pushing R1 call button on 12/24/2023. 3 out of 3 staff state that on average it takes 10 to 15 minutes for staff to respond to a residents call for help and 3 out of 3 staff state that if R1 needed help it would not take 30 minutes to respond. LPA Calderon conducted an interview with R1-R8. R1 states that R1 lost R1 balance and fell hitting R1 head on the bathroom doorknob. R1 states that this happened on 12/24/2023 around 9pm. R1 states that R1 pushed the call button for help, and it took staff 30 minutes to arrive and help R1. R1 states that in the 30 minutes that passed R1 got off the floor under R1 own power. 7 out of 7 resident states that they have pushed the call button and it takes 10 to 15 minutes for staff to arrive and help. 7 out of 7 residents state that they are happy with the services provided by staff. Reviewed the front desk log notes (date 12/24/2023), there is no record of R1 calling or pushing the call button for help. There is no record of R1 falling on 12/24/2023.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
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: 5 of 6
Control Number 11-AS-20240102083125
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 speaks to resident in an inappropriate manner.

This complaint alleged that Administrator Michael Mendoza A1 speaks to R1 in English and not in Spanish which R1 cannot understand. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that A1 does not speak Spanish and many times A1 has spoken to R1 with no issues. A1 states that R1 does understand what A1 is saying and anytime there is something important to tell R1 there is another staff member that speaks Spanish to translate for R1 and A1. A1 states that A1 does not believe that A1 speaks to R1 in an inappropriate manner. LPA Calderon conducted an interview with S1-S3. 3 out of 3 staff state that they have spoken to R1 in Spanish many times and there are many Spanish speaking staff that R1 can communicate with or help A1 translate if needed. LPA Calderon conducted an interview with R1-R8. R1 states R1 only speaks Spanish. R1 states that A1 speaks to R1 in English and R1 can not understand what A1 is saying to R1. R1 states that R1 does not speak English and R1 has a hard time communicating with A1. R1 states there is no staff R1 can speak to in Spanish. 7 out of 7 residents state that there are many staff that only speak Spanish and they have a hard time communicating with those staff. 7 out of 7 residents state no issues communicating with A1.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
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 6
Control Number 11-AS-20240102083125
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 #4: Staff do not allow residents to possess personal belongings.

This complaint alleged that staff do not allow R1 to have shower towels and extra toilet paper. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that each resident is given 2 shower towels and 2 rolls of toilet paper per week. A1 states that if a resident purchases their own towels or toilet paper there is no reason that residents can not keep them. A1 states that the towels and toilet paper in question are purchased by the facility and no resident can keep more than 2 towels or toilet paper per week. A1 states that A1 spoke to R1 and advised R1 that A1 would replace any personal items owned by R1. LPA Calderon conducted an interview with S1-S3. 3 out of 3 staff state that residents do purchase extra towels and toilet paper and it is possible when housekeepers clean the resident’s room and pick up the dirty clothes that the residents’ towels are also picked up and taken to the wash. 3 out of 3 staff state that no extra toilet paper is collected unless the resident tells them they purchased the extra rolls. LPA Calderon conducted an interview with R1-R8. R1 states that R1 friend purchased 4 towels and they were a gift from R1 friend. R1 states that R1 friend also purchased toilet paper. R1 states that R1 needs extra towels and extra toilet paper, and the facility only supplies 2 towels and 2 rolls of toilet paper per week. R1 states that staff took the extra towels and toilet paper away from R1 room and would not return R1 belongings. 7 out of 7 residents state that they have purchased extra towels and toilet paper and staff do not take their items. 7 out of 7 residents state that staff does clean their dirty towels and some time they are not returned. 7 out of 7 residents state that staff do allow them to possess personal items that they purchase.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
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 6
Control Number 11-AS-20240102083125
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 #5: Staff do not assist residents with showering.

This complaint alleged that staff do not assist R1 with showering. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that R1 is given 3 showers per week. A1 states that R1 needs help to shower due to R1 medical issues. A1 states that R1 is never refused by staff to help take a shower. LPA Calderon conducted an interview with S1-S3. 3 out of 3 staff state that R1 is given 3 showers per week and that staff helps R1 with showering needs. LPA Calderon conducted an interview with R1-R8. R1 states that there are no issues with R1 showering needs. R1 states that staff does help R1 take a shower 3 times per week. 7 out of 7 residents state that they can take a shower any time they want, and staff are there to help if needed. Reviewed the physician report (date 10/10/2023), R1 needs help from staff to take a shower. Reviewed the shower logs (date 12/22/2023), logs note that staff helps R1 take a shower 3 times per week.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “staff did not assist resident with obtaining care” “staff do not answer residents call button in a timely manner” “staff speaks to resident in an inappropriate manner” “staff did not allow resident to possess personal belongings” “staff do not assist resident with showering” 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.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
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 6