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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 08/16/2024
Date Signed: 08/16/2024 04:45:10 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
07/25/2024 and conducted by Evaluator Regina Cloyd
COMPLAINT CONTROL NUMBER: 11-AS-20240725105353
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: 93DATE:
08/16/2024
UNANNOUNCEDTIME BEGAN:
09:41 AM
MET WITH:Executive Director Michael Mendoza TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff yelled at resident in care.
Staff does not ensure resident is administered medications.
Staff does not follow resident's dietary orders.
Staff does not ensure resident's room is clean.
INVESTIGATION FINDINGS:
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On 08/16/2024 Licensing Program Analyst (LPAs) Regina Cloyd and Hollie Enriquez conducted a subsequent complaint investigation at the above facility to address the following allegation. LPA Cloyd met with Assistant Administrator Tonantzin Martinez and explained the purpose of the visit. During today’s investigation, LPA Cloyd interviewed five (5) staff members and LPA Enriquez interviewed ten (10) residents.

On 07/31/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegation. LPA Cloyd met with Executive Director Michael Mendoza and explained the purpose of the visit. The investigation consisted of the following: During today’s investigation, LPA Cloyd reviewed food menus and incident report, one resident record, and interviewed five (5) staff members which include the Executive Director, MedTech, Housekeeper, Cook/Server and Caregiver/MedTech. Due to positive COVID cases in the facility, the above allegation needs further investigation. An exit interview was held with Executive Director Michael Mendoza and a copy of this report was provided. Continue to LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
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 4
Control Number 11-AS-20240725105353
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: 08/16/2024
NARRATIVE
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Allegation(s):
Staff yelled at resident in care.

The investigation revealed the following: Regarding the allegation " Staff yelled at resident in care,” it is being alleged that a nurse yelled and interrupted resident #1 (R1). Eight (8) out of (8) eight staff interviews indicated that they have not witness staff yelling at residents. Eight (8) out of (9) nine resident interviews indicated that they like the staff and have never been yelled at. Regarding the allegation “Staff yelled at resident in care,” based on interviews, the Department found no evidence to support the allegation mentioned above. Although 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, as a result, the allegation is Unsubstantiated.



No deficiency was cited for this allegation.

Allegation(s):
Staff does not ensure resident is administered medications.



The investigation revealed the following: Regarding the allegation "Staff does not ensure resident is administered medications,” it is being alleged that Resident #1 (R1) did not receive R1’s noon medication on 07/13/24. One LVN, Two MedTech, and One Caregiver interview indicated that medication is passed out in the dining hall and staff will go to residents’ room if they miss medication at mealtimes. Staff #5 (S5) indicated that S5 gave R1’s medication in R1’s room on 07/13/24. S5 stated that S5 observed R1 take R1’s medication. Record review revealed that S5 had a technical issue with scanning R1’s medication and S5 indicated that the medication record is blank because of the technical issue. Seven (7) out of (9) nine resident interviews indicated that staff have not forgotten to give them medication. Regarding the allegation “Staff does not ensure resident is administered medications,” based on record review and interviews, the Department found no evidence to support the allegation mentioned above. Although 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

Continue LIC9099-C.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20240725105353
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: 08/16/2024
NARRATIVE
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Allegation(s):
Staff does not follow resident's dietary orders.

The investigation revealed the following: Regarding the allegation " Staff does not follow resident's dietary orders.
,” it is being alleged that staff has not adhered to Resident #1’s (R1) dietary restrictions as of 07/18/24. Record review revealed that the facility’s menu offers a variety meal and beverage options that meet R1’s dietary restrictions. Two (2) out of (9) residents do have a dietary restriction and indicated that the staff meets their needs. Six (6) out of (9) nine residents do not have any dietary restrictions and indicated that they are satisfied with their meals and indicated that alternatives are provided. Eight (8) out of (8) staff interviews indicated that the facility provides alternatives to residents who have dietary restrictions. The Cook indicated that residents can have cranberry or orange juice, water, ice tea, hot tea, baked chicken, fish, tuna, mayo, and/or mustard as alternatives. Regarding the allegation “Staff does not follow resident's dietary orders,” based on record review and interviews, the Department found no evidence to support the allegation mentioned above. Although 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

Allegation(s):
Staff does not ensure resident's room is clean.

The investigation revealed the following: Regarding the allegation "Staff does not ensure resident's room is clean,” it is being alleged that housekeeping services was not provided on 07/11/24, 07/12/24, and 07/14/24.



Four (4) staff interviews, including one Housekeeper, indicated that housekeeping services are provided daily, and Resident #1 (R1) room is clean. Eight (8) out of (9) nine resident interviews indicated that housekeeping does some daily sweeping, mopping, taking out trash, and cleaning the bathroom. Eight residents also indicated that housekeeping changes their beddings and provides fresh towels if needed or at least twice a week. Regarding the allegation “Staff does not ensure resident's room is clean,” interviews, the Department found no evidence to support the allegation mentioned above. Continue to LIC9099-C.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20240725105353
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: 08/16/2024
NARRATIVE
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Although 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

An exit interview was conducted and a copy of this report was provided to the Executive Director Michael Mendoza.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4