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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 09/20/2023
Date Signed: 02/23/2024 11:51:58 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, 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
09/14/2023 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20230914152638
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: 89DATE:
09/20/2023
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:ADMINISTRATOR MICHAEL MENDOZATIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff speak inappropriately to resident's in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
THIS REPORT SUPERSEDES THE REPORT DATED 09/20/2023 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 09/20/2023 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 allegation.
During this investigation, LPA Calderon interviewed Administrator (A1), Residents (R1-R8), Staff (S1-S3). This interview was conducted on 09/18/2023 and 09/20/2023. On 09/20/2023 LPA Calderon obtained and reviewed copies of the following: Incident report (09/09/2023) and (09/15/2023). Admission Agreement (10/25/2022), Housekeeping Zone Logs (date September 2023), Physician Report (date 07/27/2023) 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: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
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 2
Control Number 11-AS-20230914152638
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: 09/20/2023
NARRATIVE
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Regarding Allegation #1: Facility staff speak inappropriately to resident in care. This complaint alleged that S1 and R1 were yelling at each other inside the facility. LPA Calderon interviewed with A1. A1 expressed that A1 did not witness the conversation between S1 and R1 on 09/09/2023. A1 expressed that R1 was having a conversation with S2 regarding a maintenance issue for R1’s room. A1 explained that S1 interrupted the conversation between R1 and S2 and R1 did not like S1’s actions. A1 reported that R1 cursed at S1 who walked away from R1. A1 explained that on 09/15/2023, A1 had S1 and R1 speak to each other, and both apologized for their actions. A1 believes that it was a miscommunication between S1 and R1. A1 expressed that A1 spoke to S1 and advised that A1 would not approve of any staff being rude or unprofessional with any resident in care. LPA Calderon interviewed (3) out of (3) staff #1-#3 (S1-S3) and reported that S1-S3 witnessed the conversation between R1 and S1 on 09/09/23 and that R1 was rude and cursed at S1. Two out of three staff stated that S1 was professional with R1. LPA Calderon interviewed with S2 who described that S2 and R1 were having a conversation close to the front desk. S2 claimed that S1 interrupted S2 and R1’s conversation. R1 did not like what S1 had done. S2 reported that R1 started to yell and curse at S1. S2 claimed that S1 walked away from R1 and did not yell or curse at R1. LPA Calderon interviewed R1 who expressed that R1 and S2 were having a conversation when S1 interrupted the conversation between R1 and S2 and was rude to R1. R1 expressed that R1 cursed at S1 and later apologized to S1 for R1’s actions on 09/09/2023. R1 expressed that R1 did not want to make a big deal out of nothing and did not want to move forward with the complaint. LPA Calderon interviewed (8) out of (8) residents #1-#8 (R1-R8) and reported that (6) out of (8) residents communicated that S1 has never been rude or yelled at residents. Two out of eight residents expressed that they have issues with S1 and S1 has been rude to residents in the past. On 09/20/2023 LPA Calderon reviewed the internal resident incident report dated 09/09/2023 and 09/15/2023. S1 reported that R1 and S2 were having a conversation. S1 interrupted the conversation as S1 needed S2’s assistance with another resident in care. S1 expressed that R1 got aggressive and cursed at S1. Reviewed summary report 09/15/2023, A1 spoke to R1 and S1 regarding the incident that happened on 09/09/2023. A1 had S1 apologize for interrupting the conversation between R1 and S2. R1 apologized for cursing at S1 and A1 feels this was a miscommunication between both parties. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has NOT been met; therefore, the allegation of “facility staff speak inappropriately to residents in care” 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: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2