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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 06/30/2021
Date Signed: 07/09/2021 03:30:04 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/20/2021 and conducted by Evaluator Jade Jordan
COMPLAINT CONTROL NUMBER: 11-AS-20210520114717
FACILITY NAME:GLEN PARK AT LONG BEACHFACILITY NUMBER:
198602134
ADMINISTRATOR:PINK, MARINA EFACILITY TYPE:
740
ADDRESS:1046 E 4TH STTELEPHONE:
(562) 432-7468
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY:208CENSUS: DATE:
06/30/2021
UNANNOUNCEDTIME BEGAN:
10:57 AM
MET WITH:Melissa FloresTIME COMPLETED:
03:45 PM
ALLEGATION(S):
1
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9
Staff are not treating resident with respect
INVESTIGATION FINDINGS:
1
2
3
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5
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9
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13
On 07/09/21 Licensing Program Analysts (LPAs) Jade Jordan, and Ana Soto conducted a subsequent complaint visit to continue Investigation regarding the above allegation(s) .
LPA was met by Excuetive Director Melissa Flores, and the purpose of the visit was explained.

Regarding Allegation: Staff are not treating resident with respect.
LPA contacted RP several times and left a voicemail. No call was returned. The complaint received indicated that a med tech staff was being rude and was making noises outside of RP’s Door. No Details or description of what kind of noise was being made, was provided.
Lpa conducted interviews with 10% of Residents in care, and interviewed staff as well. Based on Interviews with residents in care all generally stated that Staff are Respectful And have no issues with staff. Based on LPA Interviews, and Record Review the department finds that: Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit Interview conducted, copy of report provided. No citations issued during this visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade JordanTELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021
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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