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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 10/10/2023
Date Signed: 02/07/2024 03:10:47 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
10/03/2023 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20231003150531
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: 91DATE:
10/10/2023
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:ADMINISTRATOR MICHAEL MENDOZATIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Staff is not following resident's dietary needs
Staff is not providing housekeeping services to resident in care
Staff do not treat resident with dignity and respect
INVESTIGATION FINDINGS:
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7
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13
THIS REPORT SUPERSEDES THE REPORT DATED 10/10/2023 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 10/10/2023 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: LPA Calderon interviewed Administrator Michael Mendoza A1, R1-R8, S1-S2. This interview was conducted on 10/10/2023 and 02/07/2024. On 10/10/2023 LPA Calderon obtained and reviewed copies of the following: Admission Agreement (dated 10/25/2022), Physician Report (dated 07/27/2023), Incident report (dated 3/18/23, 8/16/23, 8/17/2023), Dietary Preference (dated 10/25/2022), Menu for February 2024, Tour R1 room 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: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
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-20231003150531
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: 10/10/2023
NARRATIVE
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Regarding Allegation #1: Staff are not following residents’ dietary needs. This complaint alleged that staff are feeding bell peppers and red meat to R1 and not following a dietary plan. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that R1 is not diabetic and would not have a diabetic meal plan based on R1 physician report (dated 07/27/2023). A1 states that R1 did not report to A1 that R1 was allergic to bell peppers or red meat. A1 has requested an updated physician report for R1 diet needs. A1 states that he has spoken to the dining staff and advised them to not serve R1 with peppers or red meat. A1 has given R1 a weekly food menu so that R1 can decide as to what R1 wants to eat. LPA Calderon conducted an interview with R1-R8. R1 states that R1 never advised A1 or staff that R1 was allergic to bell peppers or red meat. R1 states that he is not diabetic and R1 never received any physician order regarding R1 meal plan. R1 states that dining staff have worked with him regarding the peppers and red meat and A1 has given R1 a copy of the menu so that R1 can decide for R1 meals. 7 out of 8 residents state to have no issues with the food served in the dining room. LPA Calderon reviewed the R1 dietary preferences (dated 10/25/2022). Restrictions none, lactose intolerant, does not like red meat. There is no documentation that R1 is allergic to bell peppers or red meat. LPA Calderon reviewed physician report (07/27/2023) for R1. There is no documentation that R1 is diabetic or allergic to bell peppers or red meat. Reviewed incident report (date 10/25/2022) report mentions R1 not a red meat eater, does not like bones or ham.

Regarding Allegation #2: Staff is not providing housekeeping services to resident in care.

This complaint alleged that staff are not cleaning R1 room. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that staff do not clean any residents room 7 days a week. A1 states that S1-S2 clean residents’ rooms 3 to 4 times a week and touch every room 6 times a week by taking out the trash. LPA Calderon conducted an interview with S1-S2. 2 out of 2 staff state that they clean R1 room 4 times a week and make sure trash is picked up 6 times a week or as needed. LPA Calderon conducted an interview with R1. R1 states that staff do pick up trash from R1 room. R1 states that staff clean R1 room 5 times per week. LPA Calderon conducted an interview with R2-R8. 7 out of 8 residents state that staff clean their rooms 4 times a week. 7 out of 8 residents state that the staff clean their rooms 3 times a week. LPA Calderon reviewed R1 admission agreement (dated 10/25/2022). There is no documentation of how many times staff are too clean R1 room, there is documentation which state, “cleaning bed and bath linens weekly or as often as needed” and “cleaning of residents room”. On 02/07/2024 LPA Calderon inspected R1 room. R1 lives alone and R1 room is clean and there is no trash found on the floor. LPA Calderon noted staff cleaning R1 bathroom and R1 bathroom was clean.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

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

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 11-AS-20231003150531
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: 10/10/2023
NARRATIVE
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Regarding Allegation #3: Staff do not treat residents with dignity and respect.

This complaint alleged that Administrator Michael Mendoza A1 has been disrespectful when speaking to R1. LPA Calderon conducted an interview with Administrator Michael Mendoza (A1). A1 states that A1 has spoken to R1 many times and has never been rude or disrespectful. A1 states that A1 has an open-door policy and has spoken to R1 many times with no issues. A1 states that A1 treats R1 with dignity and respect. LPA Calderon conducted an interview with R1-R8. R1-R2 states that Administrator Michael Mendoza is rude and disrespectful to R1-R2. R1-R2 states that all other staff treat R1-R2 with dignity and respect when speaking to R1-R2. 6 out of 8 residents states to have no issues or concerns about A1 or staff and all staff deal with them professionally. LPA Calderon followed up with R1-R2 on complaint. R1 states that A1 had been rude to R1 by interrupting what R1 had to say, but A1 has been professional with R1 and takes care of R1 needs. R2 states that in the past A1 would interrupt what R2 was trying to say, but was never unprofessional with R2.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegations of “staff is not following residents’ dietary needs” “staff is not providing housekeeping services to residents in care” “staff do not treat resident with dignity and respect” 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: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3