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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 09/16/2024
Date Signed: 09/16/2024 01:05:36 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
09/12/2024 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240912101113
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: 88DATE:
09/16/2024
UNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Michael Mendoza/AdministratorTIME COMPLETED:
01:05 PM
ALLEGATION(S):
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Staff did not safeguard resident's funds.
Staff is acting as the payee for several independent residents.
Staff do not treat residents with dignity or respect.
INVESTIGATION FINDINGS:
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On 9/16/2024 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Michael Mendoza /Administrator. LPA explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Resident’s interviews (R#1-R#8) and Staff Interviews (S#1-S#2). LPA obtained and reviewed the following documents: Resident’s roster, Personnel roster, (R#1-R#6) Identification and Emergency Information,(R#1-R#6) Safeguard for Property and Valuables or LIC 621 ,(R#1-R#6) Record of Client's/Resident's Safeguarded Cash Resources of LIC 405 from 1/1/24-9/4/24,, (R#1-R#6) Physicians Report for Residential Care Facilities for the Elderly or LIC 602A, (R#1-R#6) Social Security Letters, and (R#1)’s invoice clothing receipt dated 7/15/24.

Evaluation Report continues LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
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-20240912101113
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: 09/16/2024
NARRATIVE
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Investigation Revealed the Following:

Allegation: Allegations: Staff did not safeguard resident's fund.

The details of the complaint alleged that facility staff is not safeguarding (R#1)’s funds properly.



During the records review, LPA Iniguez reviewed (R#1-R#6) copies of the Record of Client's/Resident's Safeguarded Cash Resources of LIC 405; LPA Iniguez observed that the facility has a record of all (R#1-R#6) expenditures from January 2024 until Now. In addition, LPA observed (R#1) 's P&I ledger; it is written that there was an expenditure record from 7/18/2024 for $810.25 check number (CK15509) for (R#1) 's clothing. Moreover, LPA observed a copy of an invoice from Professional Fit Clothing (Clothing Company) dated 7/15/2024. This company provided (R#1) (5) pairs of pants, (5) designer polos, and (2) 3-pack undershirts; the total amount for all this was $810.25. Also, LPA Iniguez observed copies of (R#1)’s Personal Property Inventory created by the facility, on this form it is listed all (R#1)’s personal property.

During an interview with the Administrator (A#1), he stated that the facility safeguards (R#1) 's and the other residents' belongings using an itemized list on-site and a P&I list. Also, (A#1) stated that the facility could give the residents cash if requested as part of their P&I. In addition, (A#1) stated that the $810.25 was used to buy (R#1) 's clothes in July of this year.

During interviews with staff 1 (S#1), they stated that the facility keeps a ledger for all the residents, including (R#1), who need assistance with their finances. Also, (S#1) stated that the $810.25 was used to buy (R#1)' ’s clothes back in July.

During an Interview with (R#1), they stated that they got new clothes recently. Also, (R#1) stated that they think they can get access to their P&I finds; they just did not know they had money.

Evaluation Report continues LIC 9099-C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20240912101113
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: 09/16/2024
NARRATIVE
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During interviews with residents (R#2-R#6), (5) out of (5) residents stated that they can get access to their P&I funds every week.

During an interview with Witness 1 (W#1), they requested P&I money from (R#1) and found $810.25 to buy them clothes. However, (W#1) spoke with (R#1), and they stated that they had not gotten new clothes, and there was no receipt showing that the new clothes had been purchased on behalf of (R#1).

Allegation: Staff is acting as the payee for several independent residents.

The details of the complaint alleged that facility staff is acting as the payee for several residents in care. During the records review, LPA Iniguez reviewed (R#1)’s Physicians Report for Residential Care Facilities for the Elderly or LIC 602A; it is written that (R#1) is not confused or disoriented, able to follow instructions and to communicate their needs, on the other hand, (R#1) is not able to manage their cash resources. Also, LPA observed (R#2-R#6) LIC 602A, indicating they cannot manage their finances. In addition, LPA observed copies from the Social Security Administration, and it is written that the facility is the payee for (R#1-R#6).



During an interview with the Administrator (A#1), he stated that the facility is the payee for (R#1). The Social Security Administration appointed us to be (R#1)’s payee on 7/15/2022.

During interviews with staff 1 (S#1), they stated that the facility is the appointed payee by the Social Security Administration for (R#1-R#6).

Evaluation Report continues LIC 9099-C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20240912101113
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: 09/16/2024
NARRATIVE
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Allegation: Staff do not treat residents with dignity or respect.

The details of the complaint alleged that facility administrator does not treat residents with dignity and respect.



During an interview with the Administrator (A#1), he stated that he treats the residents in care with dignity and respect and that does not intimidate them.

During interviews with staff (S#1-S#5), (5) out (5) facility staff stated that (A#1) treats the residents in care with dignity and respect and does not intimidate them.

During interviews with residents (R#1-R#6), (6) out of (6) residents stated that (A#1) treats them with dignity and respect and they do not feel intimidated by him.

During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.


An exit interview was conducted, and a copy of the Complaint Report was given to Michael Mendoza /Administrator.

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso IniguezTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4