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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 12/20/2023
Date Signed: 12/20/2023 04:31:38 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
12/18/2023 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 11-AS-20231218161430
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: 101DATE:
12/20/2023
UNANNOUNCEDTIME BEGAN:
08:01 AM
MET WITH:Micheal MendozaTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff did not meet resident's dietary needs.
Staff did not clean resident's room.
staff yelled at resident.
Staff made inappropriate comment toward resident.
INVESTIGATION FINDINGS:
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On 12/20/2023, Licensing Program Analyst (LPA) Antonine Richard conducted a complaint visit to deliver findings regarding the above allegations. LPA Richard met with Administrator Michaell Mendoza and explained the reason for the visit.

The investigation consisted of the following:
On 12/20/2023, LPA Richard and Administrator Mendoza toured the facility inside and out.
LPA Richard reviewed and requested, staff and resident's roster. Internal resident incident report, Individual Services Plan (ISP), Winter Menus 2023, Sanitation and Food Safety Checklist for Assisted Living, Daily Housekeeping Schedule, R1 hand writing note, Physician's Report for Residential Care For the Elderly (RCFE). LPA interviewed tens (R2-R10) residents, and seven staff (S1-S7). LPA Richard toured the kitchen and spoke to S2 about resident's dietary needs.

This report is cotinued, please see LIC9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
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-20231218161430
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: 12/20/2023
NARRATIVE
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Allegation #1: Staff did not meet resident's dietary needs.

On 12/20/2023, LPA Richard conducted an interview with seven staff (S1-S7), all staff stated that the cook follows a meal plan and serve nutritious meals 3 times per day. 7 days a week. S2 stated that not all resident love the food served but the menu has a choice that resident could choose if they don't like what was the main dish. LPA Richard conducted an interview with S2. S2 states that his has been a cook for over 8 years and a cook for the facility for 1 year. S2 stated that S2 follows a meal plan and serves nutritious meals every day. LPA Richard conducted an interview with R1-R10. R1 stated that staff refuses to serve R1 lunch when R1 is out of the facility. R1 stated that the food is not good and not nutritious. 9 out of 10 residents stated that the food is delicious and 9 out of 10 residents have no issues with the food served. LPA Reviewed facility meal plan of residents.

Based on interviews, observations and records reviews the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegation of “Staff did not meet resident's dietary needs" is UNSUBSTANTIATED.

Allegation #2: Staff did not clean resident's room.

On 12/20/23, LPA Richard conducted an interviewed with seven staff (S1-S7) all staff and Administrator Michael Mendoza (S1) stated that staff does clean residents’ room 5 days a week. S1 stated that (S2-S3) clean residents’ room 5 times a week and touch every room 4 times a week by taking out the trash and cleaned the bathroom. LPA Richard conducted an interview with (S2-S7). 3 out of 7 staff stated that they clean R1 room 5 times a week and make sure trash is picked up every time. LPA Richard conducted an interview with R1-R10. 9 out of 10 residents stated that staff clean their rooms 4 times a week. 8 out of 10 residents stated that the staff deep clean twice a week. LPA Richard reviewed R1 admission agreement there is no documentation stated how many time the facility need to clean resident’s room.

Based on interviews, observation and record reviews the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation staff did not clean resident's room is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20231218161430
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: 12/20/2023
NARRATIVE
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Allegation #3: Staff yelled at resident.

On 12/20/23, LPA Richard conducted an interview with seven staff (S1-S7) and Administrator Michael Mendoza (S1). S1 stated that he has spoken to R1 many times and has never yelled at R1. S1 stated that he has an open-door policy and has spoken to R1 many times with no issues. S1 stated that he treats all staff and resident with respect, yelling at someone wouldn’t resolved any issue. LPA Richard conducted an interview with ten Residents (R1-R10). R1 stated that Administrator Michael Mendoza is very rude and yells at all the residents all the time. R1 stated that most of the staff doesn’t yell at residents R1-R10 when speaking to them R1-R2. 9 out of 10 residents stated they have no issues or concerns about S1. LPA Richard reviewed incident reports there is no mention of yelling at residents.

Based on interviews, observations, and record reviews 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 staff yelled at resident is UNSUBSTANTIATED.

Allegation #4: Staff made inappropriate comment toward resident.

On 12/20/23, LPA Richard conducted an interview with seven staff (S1-S7) and Administrator Michael Mendoza (S1). S1 stated that he has spoken to R1 many times and has never made inappropriate comments towards anyone, staff or resident. S1 stated that he has not spoken inappropriate mean and loudly when speak to resident. LPA Richard interviewed ten Residents (R1-R10). R1 stated that most of the staff are nice and considerate toward residents when speaking to them. 9 out of 10 residents stated they have not experienced inappropriate comment from S1 since they’ve being living here. LPA Richard reviewed incident reports there is no mention of S1 made inappropriate comment toward resident.

Based on interviews, observations, and record reviews 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 staff made inappropriate comment toward resident is UNSUBSTANTIATED.

An Exit interview was conducted with the Administrator Michael Mendoza and a copy of the report was provide

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine RichardTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3