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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 11/07/2024
Date Signed: 11/15/2024 10:48:07 AM

Substantiated


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
04/19/2024 and conducted by Evaluator Pamela Bunker
COMPLAINT CONTROL NUMBER: 11-AS-20240419102426
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: 95DATE:
11/07/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jonathan BarriosTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff engaged in an intimate relationship with a resident.
INVESTIGATION FINDINGS:
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***The original complaint report, dated Thursday, November 7, 2024, has been amended to correct the LIC9099, LIC9099-Cs, and LIC9099-D, This amended complaint report, dated Thursday, November 14, 2024, supersedes the original complaint report dated Thursday, November 7, 2024.***

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Thursday, November 07, 2024, upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a risk assessment. Based on the assessment, the facility is cleared of COVID-19 infection. The department then met with Co-Executive Director Jonathan Barrios and explained that the purpose of the visit was to complete the 10-day complaint investigation initiated on Monday, April 22, 2024.

The investigation consisted of the following: During the course of the investigation Interviews were conducted. The department posed questions pertinent to the nature of the complaint. The department requested and reviewed resident and staff records. See continued LIC9099-C, page 2
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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 6
Control Number 11-AS-20240419102426
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: 11/07/2024
NARRATIVE
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Continued LIC9099-C page 2

The Department obtained copies of the following documents: The staff and residents roster, admission agreement, physician's report, medical assessment, medication administration records (MARs), consent forms, replacement appraisal information, identification and emergency information, appraisal needs and service plan, safeguards for cash resources, staff training on reporting dependent and adult and elder abuse, staff in-service training, and ongoing staff training.

Allegation: Staff engaged in an intimate relationship with a resident.
It was alleged that the staff engaged in an intimate relationship with a resident. The department investigated the allegation. Interviews were conducted with staff members 1-4 (S1-S4) and facility residents 1-10 (R1-R10). A resident reported maintaining a dating and sexual relationship with a facility staff member. The staff admitted to having a sexual relationship with the facility resident, and both the resident and staff member reported going to a local motel together. The department corroborated this information with a printout of the reservation from the local motel. There is sufficient evidence to support the allegation that the facility staff was involved in an intimate relationship with the facility resident.

The investigation revealed the following:
The Department conducted interviews with staff members 1-4 (S1-S4) and residents (R1-R10). S1-S2 stated that on 04/18/2024, a resident came into the office to report a dating relationship with a staff member that had been ongoing for approximately six weeks. The resident ended the relationship due to the age difference and because the staff member was harassing the resident for the $4,000.00 that the staff member claimed to have spent on the relationship. Both the resident and staff member admitted to the Department that they had been in a consensual romantic and intimate relationship for about two to three months. They both stated that no elder abuse occurred and that the relationship was consensual.

Staff member S4 stated he was not employed at the facility at the time of the alleged incident and had no knowledge of the allegation.


See continued LIC9099-C page 3
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 11-AS-20240419102426
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: 11/07/2024
NARRATIVE
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Continued LIC9099-C page 3

Residents R2-R10 stated they had never witnessed or heard of any resident being in a consensual relationship with staff. Staff members S1-S4 stated that the facility has a zero-tolerance policy against inappropriate relationships between staff and residents. S1 also stated that a Special Incident Report had been reported to the appropriate agencies in a timely manner, prior to the complaint allegation.

Based on the Department's observations, interviews that were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D.

Appeal rights were discussed, and copies of the Complaint Investigation Report LIC9099, LIC9099-Cs, and LIC9099-D were provided to Co-Executive Director Jonathan Barrios.

An exit interview was conducted.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
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
04/19/2024 and conducted by Evaluator Pamela Bunker
COMPLAINT CONTROL NUMBER: 11-AS-20240419102426

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: 95DATE:
11/07/2024
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Jonathan BarriosTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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2
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9
Staff financially exploited resident.

INVESTIGATION FINDINGS:
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13
***The original complaint, dated Thursday, November 7, 2024, has been amended to correct the LIC9099-A and LIC9099A-C. This amended complaint report, dated Thursday, November 14, 2024, supersedes the original complaint report dated Thursday, November 7, 2024.***
On Thursday, November 07, 2024, the department conducted an unannounced complaint visit. Upon arrival at the facility, the department contacted the facility by telephone and conducted a risk assessment. Based on this assessment, the facility was cleared of any COVID-19 infections. The department then met with Co-Executive Director Jonathan Barrios and explained that the purpose of the visit was to complete the 10-day complaint investigation initiated on Monday, April 22, 2024.
The investigation consisted of the following: The department conducted interviews with staff members 1-4 (S1-S4), residents 1-10 (R1-R10), and Staff 4 (S4), who stated that he was not an employee at the time of the alleged incident and had no knowledge of the allegation. The department asked questions pertinent to the nature of the complaint and requested staff and resident records for review.
See continued LIC-9099-C page 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 11-AS-20240419102426
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: 11/07/2024
NARRATIVE
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Continued LIC9099-C, page 2
The Department obtained copies of the following documents: The staff and residents roster, admission agreement, physician's report, medical assessment, medication administration records (MARs), consent forms, replacement appraisal information, identification and emergency information, appraisal needs and service plan, safeguards for cash resources, staff training on reporting dependent and adult and elder abuse, staff in-service training, and ongoing staff training.
Allegation: Staff financially exploited a resident.
The Department conducted interviews regarding the allegation that staff financially exploited a resident. Staff members 1 and 4 (S1-S4) stated they conducted an investigation after being notified of the incident by the resident. However, the facility had no evidence of any staff financially exploiting a resident. There were no witnesses or documents indicating that the resident owed any money to the staff member. S1-S4 stated that the facility has a zero-tolerance policy against inappropriate relationships between staff and residents.
The resident stated he was in a consensual relationship with one of the staff members. According to the resident, after he ended the relationship, the staff member began harassing the resident, claiming the resident owed the staff $4,000 for money the staff had spent on the resident during the relationship. The resident explained that he is on a fixed income, did not agree to reimburse the staff member, and does not have the money to do so. A resident reported that on 04/18/2024, the staff member again requested the alleged amount. The resident stated he went to the administrator to file a complaint, wanting the harassment to stop and avoid further contact. Neither the resident nor the staff member provided receipts or documentation regarding the amount claimed. The resident no longer resides at the facility, and the staff member is no longer employed there. Residents 1 through 10 (R1-R10) reported satisfaction with the facility, stating that the staff provides a comfortable living environment and meets their daily needs. All residents (R2-R10) stated that they have never experienced financial exploitation by staff. Staff 4 (S4), stated that he was not an employee at the time of the alleged incident and had no knowledge of the allegation. The Department did not have sufficient evidence to determine the veracity of the allegation.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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, therefore the allegation is deemed unsubstantiated.
A copy of the Complaint Investigation Report LIC9099-A, and LIC9099-C was provided to the Co-Executive Director Jonathan Barrios. There were no deficiencies cited. An exit interview was conducted
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 11-AS-20240419102426
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/15/2024
Section Cited
CCR
87468.1(a)(1)
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87468.1 (a) (2) Personal Rights of Residents in All Facilities.
To be accorded dignity in their personal relationships with staff, residents, and other persons.
Staff engaged in an intimate relationship with a resident.
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The Licensee is required to submit a written plan addressing residents' personal rights, ensuring residents are provided with dignity in their personal relationships with staff, residents, and other persons.
The plan must be submitted by the POC deadline of, Monday, November 18, 2024.
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This violation poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6