198602134-2-7-2024-11-AS-RORN-D2PVA9-20240222151533

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 02/07/2024
Date Signed: 02/07/2024 11:56:11 AM

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
01/24/2024 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20240124103401

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: 92	DATE:	02/07/2024
		UNANNOUNCED	TIME BEGAN:	11:32 AM
MET WITH:	Executive Director Micheal Mendoza		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff did not prevent a resident from physically assaulting another resident in care.
Staff did not administer medication as prescribed.

INVESTIGATION FINDINGS:

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On 02/07/24 LPA Villegas conducted a sebsequent visit to render inestigation findings regarding the allegation(s) above. LPA met with Executive director (ED) Michael Mendoza as the purpose of todays visit was explained.

The investigation consisted of the following: On 02/02/24 LPA interviewed Executive Director (ED), staff #1-6 (S1-S6), and interviewed residents # 3-8 (R3-R8). LPA obtained copies of the following for R1, R2 and R3; emergency Identification form, care plan, physicians report, med list, E-mar for January 2024, and preplacement appraisal information. On 02/02/24 LPA also obtained a staff and resident roster, a copy of the incident report for 01/19/24, SOC 341, copies of internal incident reports for 01/19/24, and conducted a medication review.

The investigation revealed the following:
Allegation: Staff did not prevent a resident from physically assaulting another resident in care.
It is being alleged staff did not prevent a resident from physically assaulting another resident in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20240124103401

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: 02/07/2024

NARRATIVE

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02/02/24 LPA interviewed ED regarding the above allegation, ED denied the allegation above stating that residents are separated, redirected, investigation is conducted, and additional support is provided. Ed continued to report that the facility has a zero tolerance policy for violence therefore if a assault occurs POA's are contacted immediately and asked to pick up the resident in question. On 02/02/24 LPA interviewed S1-S6 regarding the allegation above, 6 of 6 staff interviewed denied the allegation above stating that staff will separate residents, will talk to each resident individually, offer activities and will report the situation to upper management right away. On 02/02/24 LPA interviewed R3-R8 regarding the allegation above, 6 of 6 residents interviewed denied the allegation and reported feeling safe at the facility. On 02/02/24 LPA was unable to interview R2-R3 as R2-R3 where not in the facility, on 02/05/24 LPA was able to interview responsible party (W2) for R1, W2 reported there are no concerns at this time. On 02/06/24 LPA was able to interview R2, R2 denied having any altercations with R1. R1 was unable to provide details on incident in question.

Allegation: Staff did not administer medication as prescribed.
It is being reported that staff did not administer medication as prescribed. 02/02/24 LPA interviewed ED regarding the above allegation, ED denied the allegation above stating that medications are being provided as directed by Doctor. ED continued to report that there have not been any complaint regarding medications, however residents have complained about not being able to store medications in their rooms. On 02/02/24 LPA interviewed S1-S6 regarding the allegation above, 2 of the 6 staff interviewed denied the allegation reporting Doctors orders are being followed. 2 of 6 staff interviewed continued to report there is a 1 hour window where the medication can be administered 1 hour before or 1 hour after the documented medication time, 2 of 6 staff also indicated that some residents may be provided their medications first when a resident has an urgency. 4 of the 6 staff interviewed reported not they do not assist with medication administration. On 02/02/24 LPA interviewed R3-R8 regarding the allegation above, 5 of 6 resident's denied the allegation above and reported receiving medications daily and on time. 1 of 6 residents reported medication administration has improved but there are still issues that need to be fix. On 02/02/24 LPA conducted a medication review and did not observe any discrepancies, medication administrations, medication times and signatures were observed. on 02/05/24 LPA was able to interview responsible party (W2) for R1, W2 reported there are no concerns at this time. On 02/06/24 LPA was able to interview R2, R2 denied the allegation above and reported receiving medications daily and on time.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.
Exit interview conducted with Executive Director Michael Mendoza, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

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