198602134-10-22-2024-11-AS-SCIS-DCJV62-20250102150848

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 10/22/2024
Date Signed: 10/22/2024 04:21:58 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
10/02/2024 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20241002160648

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: 90	DATE:	10/22/2024
		UNANNOUNCED	TIME BEGAN:	09:47 AM
MET WITH:	Michael Mendoza, Executive Director		TIME COMPLETED:	04:23 PM

ALLEGATION(S):

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Staff do not treat resident with dignity or respect
Staff are not following resident's Admission Agreement
Staff does not provide adequate food service

INVESTIGATION FINDINGS:

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On 10/18/24, Licensing Program Analyst, (LPA) Felisa Shirley conducted an unannounced subsequent visit to this facility. LPA was met by Executive Director, Michael Mendoza and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility.

The investigation consisted of the following:
On 10/8/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by Jonathan Barrios, Administrator. LPA requested LPA Shirley received copies of the following: LIC 500, Resident Roster, copies of resident file. On 10/22/24, LPA requested and received copies of: Weekly menus, Admission Agreement, and MAR.

The investigation revealed the following:

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

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-20241002160648

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: 10/22/2024

NARRATIVE

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Allegation: Staff do not treat resident with dignity or respect

It is being reported that residents are not being treated with dignity and respect. It is being alleged that a resident was not treated with respect and dignity by staff and that staff were very disrespectful to them and offered no assistance in their time of need. LPA Shirley attempted to interview R-1 several times but they refused to be interviewed. LPA Shirley mentioned this allegation about being treated with dignity and respect and resident responded that she had changed her mind and wanted to close the complaint as she hurried down the hallway. R-1 made it clear that she was no longer pursuing this complaint.

LPA Shirley interviewed staff-1 thru staff-9 (S-1 thru S-9). LPA asked, does staff treat residents with dignity and respect? Of those interviewed, 9 out of 9 answered yes. LPA interviewed Resident-2 thru Resident-9 (R-2 thru R-9). R-1 did not want to interview. LPA asked, does are you treated with dignity and respect?” Of those interviewed, 8 out of 9 answered yes and R-1 did not want to interview. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff does not provide adequate food service,” therefore the allegation is unsubstantiated.

Allegation: Staff are not following resident's Admission Agreement

On 10/22/24, LPA Shirley reviewed R-1’s Admission Agreement and did not observe an agreement to have TV service with cable nor telephone service in their room. Per interview with S-8, there are TVs in the common areas and there are phones located in the hallways for resident’s use. If a resident has a phone or TV in their room, the resident or family brought it in themselves and are paying for the service.

LPA Shirley interviewed staff-1 thru staff-9 (S-1 thru S-9). LPA asked, do Administrators honor Admission Agreements, promises agreed upon during the time of admission? Of those interviewed, 8 out of 9 answered yes, 1 staff did not know. LPA interviewed Resident-2 thru Resident-9 (R-2 thru R-9). R-1 did not want to interview. LPA asked, does Administration honor your Admission Agreement?” Of those interviewed, 8 out of 9 answered yes and R-1 did not want to interview. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff does not provide adequate food service,” therefore the allegation is unsubstantiated.

Con'd on 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20241002160648

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: 10/22/2024

NARRATIVE

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Allegation: Staff does not provide adequate food service

On 10/22/24, LPA Shirley toured the kitchen and interviewed the Cook, S6 and the Dietary Aid, S7. LPA observed that both were wearing a hair net as required. LPA observed all food preparers Certificate of Training from California Food Handlers Course posted on the kitchen wall. LPA Shirley reviewed the weekly menus and found that they contained all important food groups. LPA observed refrigerated food and did not observe any expired foods nor were there any foul odors. LPA observed, beef, chicken, pork and fish stored in the freezers and did not observe any food items that are not customary.

LPA Shirley interviewed staff-1 thru staff-9 (S-1 thru S-9). LPA asked, does staff provide adequate food service? Of those interviewed, 9 out of 9 answered yes. LPA interviewed Resident-2 thru Resident-9 (R-2 thru R-9). R-1 did not want to interview. LPA asked, does staff provide adequate food?” Of those interviewed, 6 out of 9 answered yes, 2 answered no and R-1 did not want to interview. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff does not provide adequate food service,” therefore the allegation is unsubstantiated.

There were no deficiencies cited during this visit.

LPA Shirley conducted an exit interview and a copy of this report was signed by Interim Administrator, Melissa Flores.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 10/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/22/2024

LIC9099 (FAS) - (06/04)

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