198602134-3-11-2024-11-AS-JHAD-D3SMSL-20240328095204

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 03/08/2024
Date Signed: 03/11/2024 01:18:29 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
03/25/2022 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20220325125918

FACILITY NAME:	GLEN PARK AT LONG BEACH		FACILITY NUMBER:	198602134
ADMINISTRATOR:	MELISSA FLORES		FACILITY TYPE:	740
ADDRESS:	1046 E 4TH ST		TELEPHONE:	(562) 432-7468
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	208	CENSUS: 93	DATE:	03/08/2024
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Executive Director Michael Mendoza		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Resident abuse.
Altering/falsifying records.
Resident’s personal supplies being distributed to other residents.
Uncleared staff working at facility.

INVESTIGATION FINDINGS:

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On 01/12/24 at 9:00 am, Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit to deliver complaint investigation findings regarding the allegation above. LPA met with Executive Director (ED) Michael Mendoza as the purpose of today's visit was explained.

The investigation consisted of the following; On 03/28/2022 (LPA) Cardenas conducted initial complaint visit. On 05/06/22 LPA Cardenas was unable to interview Resident #1 (R1) due to communication barriers. On 05/18/23 LPA Villegas and LPM Hammond interviewed ED, staff # 2-5(S2-S5) and obtained the following records for R1;admission agreement, Identification and emergency information, physician reports, resident appraisal, preplacement appraisal, consent forms, functional capability assessment and residents incident report notes.LPA obtained (S1) file (resume, job application, health screening, administrator certificate), (S5) file( resume, job description, health screening), (S6) file( resume, job description, health screening, administrator certification), for (S7) LPA obtained Termination statement, and for (S8) LPA obtained employment dates. On 03/08/24 LPA interviewed residents 2-11 (R2-R11) and obtained a copy of the staff

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: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

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 3

Control Number 11-AS-20220325125918

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: 03/08/2024

NARRATIVE

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and resident roster.

The investigation revealed the following:
Allegation- Resident abuse
It is alleged in February or March 2020, NOC shift Staff #1(S1) dragged Resident #1 (R1) across the floor by his feet from the elevator to R1’s bedroom. On 05/18/23, LPA interviewed ED regarding the allegation, ED stated he was not working at the Glen Park at Long Beach in 2020. ED denied any physical abuse occurring since he has been the Administrator. On 05/18/23, LPA interviewed Staff #2-5, 4 of the 4 staff interviewed denied the allegation. On 03/08/24, LPA interviewed R2-R1 regarding the allegation and 10 of 10 residents interviewed denied the allegations. LPA attempted to interview R1 but was unsuccessful due to communication barriers. On 05/18/23, LPA conducted a file review of the facility incident reports from 2020 and a review of R1 file and did not observe any incident reports for physical abuse. LPA conducted a file review of S1 file and did not observe any write ups for physical abuse.

Allegation-Altering/falsifying records.
It is being alleged the facility engages in fabrication and or forgery of facility records. On 5/18/23 LPA interviewed ED regarding the allegation above, ED denied the allegation stating there has been no falsifying of records at the facility. On 05/18/23 LPA interviewed S2-S5 regarding the allegation above, 4 of 4 staff interviewed denied the allegation above. On 03/08/24 LPA interviewed R2-R11 regarding the allegation above, 10 or 10 residents interviewed denied the allegation above. LPA conducted a review of files obtained and did not observe any alterations made.

Allegations- Resident’s personal supplies being distributed to other residents.
It is being alleged that residents supplies provided by family members are distributed to other residents. On 5/18/23 LPA interviewed ED regarding the allegation above, ED denied the allegation above. Per ED donations made by family members are distributed to residents who need clothes. On 05/18/23 LPA interviewed S2-S5 regarding the allegation above, 3 of 4 staff interviewed denied the allegation above. 1 of 4 staff interviewed reported that each resident has their own cognitive supplies in their own room. On 03/08/24 LPA interviewed R2-R11 regarding the allegation above, 9 or 10 residents interviewed denied the allegation above and reported never receiving any items that do not belong to the. 1 of 10 residents interviewed reported receiving items that do not belong to resident when laundry is distributed but reports providing the items back to staff right away.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220325125918

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: 03/08/2024

NARRATIVE

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Allegation: Uncleared staff working at facility.

It is being alleged that S7, former staff did not get a fingerprint clearance. On 5/18/23 LPA interviewed ED regarding the allegation above, ED denied the allegation and reported never meeting the staff in question. On 05/18/23 LPA interviewed S2-S5 regarding the allegation above, 3 of 4 staff interviewed denied the allegation above and reporting not having any knowledge of a staff member by that name. 1 of 4 staff interviewed reported S7 was from a staffing agency during covid and was not directly employed by Glen Park at Long Beach and should have been finger printed by staffing agency. On 03/08/24 LPA interviewed R2-R11 regarding the allegation above, 10 of 10 residents interviewed denied the allegation above and stated not recalling S7. On 05/06/23 LPA Villegas conducted a review of LIC 500 personnel report and compared it to licensing guardian system and confirmed all staff employed by Glen Park at Long Beach are fingerprint cleared.

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: 03/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024

LIC9099 (FAS) - (06/04)

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