<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 01/06/2025
Date Signed: 01/07/2025 09:00:55 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, 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
11/15/2024 and conducted by Evaluator Elvira Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241115103623
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: DATE:
01/06/2025
UNANNOUNCEDTIME BEGAN:
01:54 PM
MET WITH:Melissa FLoresTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff physically abused resident.
Staff was under the influence while caring and supervising resident.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 01/06/25 the department conducted a subsequent complaint visit at this facility to deliver the complaint findings. The department met with Quality Assurance Director, Melissa Flores, and the purpose of today’s visit was explained.

The investigations consisted of the following: On 11/21/24, the department interviewed staff #1-#8 (S1-S8), and residents #1-#9 (R1-R9) and conducted a facility tour. Additionally, the department received and reviewed the following documents: staff roster, resident roster, resident's shower schedule, Unusual Incident/Injury Reports dated 10/03/24, 10/31/24, and discharge paperwork from St. Mary Medical Center-Long Beach printed on 10/03/24 for R4. On 01/06/24 the department received the following documents: Medication Administration Records (MARs) for the months of October 2024 and November 2024.

Continued on LIC809-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
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 8
Control Number 11-AS-20241115103623
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: 01/06/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation revealed the following:

Allegation: Staff physically abused resident. It was alleged that a resident was physically assaulted while in care. It is also being alleged that a resident was pushed out the facilities front door. On 11/21/24, the department interviewed S1-S8 and R1-R9. Based on interviews conducted, eight (8) out of eight (8) staff interviewed said they do not know or recall of an incident where a resident was pushed out the front door. Five (5) out of eight (8) staff interviewed revealed that a resident was physically assaulted while in care back in October 2024. An interview conducted with S7 revealed that a resident was physically assaulted by a staff member on 10/02/24 and that employee had been terminated.

Based on interviews conducted, six (6) out of nine (9) residents interviewed said they did not know of an incident involving a staff member physically assaulting a resident.

Records review of an Unusual Incident/Injury Report dated 10/03/24, and discharge paperwork from St. Mary Medical Center-Long Beach revealed that on 10/02/24, a caregiver had physically assaulted a resident, and emergency services were called. St. Mary Medical Center discharge paperwork revealed that R4 was seen on 10/02/24 for a facial injury. The discharge diagnosis was blunt trauma, abrasions of multiple sites, and subconjunctival hemorrhage.

Based on observation, interviews conducted, and a review of records, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California code of Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D.



Allegation: Staff was under the influence while caring and supervising resident. It was alleged that a med-tech was sent home after being under the influence while administering medication. Based on interviews conducted, five (5) out of eight (8) staff interviewed revealed that they knew of a med-tech being under the influence while administering medication. An interview with S7 revealed that a other staff reported to management that a med-tech was under the influence. That staff member then admitted to being under the influence and was sent home and terminated.

Based on interviews conducted, five (5) out of nine (9) residents interviewed said they did not know of an incident involving a staff member being under the influence while administering medication.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 11-AS-20241115103623
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: 01/06/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
 Records review of an Unusual Incident/Injury Report dated 10/31/24 revealed that on 10/29/24, an employee admitted to being under the influence while at work. The employee was removed from the building and terminated.

Based on observation, interviews conducted, and a review of records, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California code of Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D.

An exit interview was conducted with Quality Assurance Director, Melissa Flores, and a copy of the report and appeal rights was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 11-AS-20241115103623
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/07/2025
Section Cited
CCR
87468.1(a)(3)
1
2
3
4
5
6
7
87468.1 (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.


1
2
3
4
5
6
7
Licensee will ensure staff review and sign the facility General Personnel Policies, residents Personal Rights, and Violations or infractions of Company Policy, and email a copy to LPA by POC.
8
9
10
11
12
13
14
This requirement was not met as evidence:
Based on interviews, records review, Executive Director Gloriella Jara stated that an employee had physically assaulted R4, which posed an immediate health, safety, and personal rights risk to R4.
8
9
10
11
12
13
14
Type A
01/07/2025
Section Cited
CCR
87411(f)
1
2
3
4
5
6
7
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks.
1
2
3
4
5
6
7
Licensee will ensure staff review and sign the facility General Personnel Policies, residents Personal Rights, and Violations or infractions of Company Policy, and email a copy to LPA by POC.
8
9
10
11
12
13
14
This requirement was not met as evidence:
Based on interviews, records review, Executive Director Gloriella Jara stated that an employee had admitted to being under the influence while at work, which posed an immediate health, safety, and personal rights risk to residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 8
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
11/15/2024 and conducted by Evaluator Elvira Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241115103623

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: DATE:
01/06/2025
UNANNOUNCEDTIME BEGAN:
01:54 PM
MET WITH:Melissa FLoresTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not properly documenting resident's medications when administered.
Staff do not ensure resident's showering needs are being met.
Staff do not ensure resident's health care needs are being met.
Staff do not have a background clearance.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 01/06/25 the department conducted a subsequent complaint visit at this facility to deliver the complaint findings. LPA met with Quality Assurance Director, Melissa Flores and the purpose of today’s visit was explained.

The investigations consisted of the following: On 11/21/24, the department interviewed staff #1-#8 (S1-S8), and residents #1-#9 (R1-R9) and conducted a facility tour. Additionally, the department received and reviewed the following documents: staff roster, resident roster, resident's shower schedule, Unusual Incident/Injury Reports dated 10/03/24, 10/31/24, and discharge paperwork from St. Mary Medical Center-Long Beach printed on 10/03/24 for R4. On 01/06/24 the department received the following documents: Medication Administration Records (MARs) for the months of October 2024 and November 2024.

Continued on LIC809-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 11-AS-20241115103623
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: 01/06/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
The investigation revealed the following:

Allegation: Staff are not properly documenting resident's medications when administered. It is alleged that the MARs are incorrect and are being tampered with. On 11/21/24, the department interviewed S1-S8 and R1-R9. Based on interviews conducted, eight (8) out of eight (8) staff interviewed stated that the MARs are correct. Eight (8) out of eight (8) staff interviewed stated that the MARs have not been tampered with by staff.

Based on interviews conducted, seven (7) out of nine (9) residents interviewed said that staff administers their medication daily and on time. Seven (7) out of nine (9) residents interviewed revealed that they don’t know if the MARs are incorrect or if they have been tampered with.

On 01/06/25, the department reviewed MARs for the month of October 2024 and November 2024 and observed the MAR’s to be complete and in order.

Based on observation, interviews conducted, and a review of records, 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, therefore the allegation is UNSUBSTANTIATED.

Allegation: Staff do not ensure resident's showering needs are being met. It is alleged that residents are not showering. Based on interviews conducted, eight (8) out of eight (8) staff interviewed stated that resident’s follow a shower schedule. Eight (8) out of eight (8) staff interviewed stated that the resident’s shower 2-3 times a week.

Based on interviews conducted, seven (7) out of nine (9) residents interviewed said that they do shower. Seven (7) out of (9) residents interviewed revealed that staff ensure their showering/hygiene needs are being met. Seven (7) out of nine (9) residents interviewed revealed they are satisfied with the services being provided by staff at this facility.


Continued on LIC809-C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 8
Control Number 11-AS-20241115103623
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: 01/06/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
A review of records, of the resident's Shower Schedule revealed that the residents are scheduled to at least two (2) showers a week.

Based on observation, interviews conducted, and a review of records, 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, therefore the allegation is UNSUBSTANTIATED.

Allegation: Staff do not ensure resident's health care needs are being met. It is alleged that staff is not checking resident’s blood pressure before administering medication. It is also being alleged that hospice residents do not get food and that the resident’s don’t get physical therapy. Based on interviews conducted, eight (8) out of eight (8) staff interviewed stated that staff ensures to check resident’s blood pressure if and when needed. Eight (8) out of eight (8) staff interviewed said that residents are provided three (3) meals a day, and snacks in between. Eight (8) out of eight (8) staff interviewed revealed that all residents who require physical therapy get it as scheduled. Eight (8) out of eight (8) staff interviewed stated that they make sure that the residents care needs are being met daily.

Based on interviews conducted, five (5) out of nine (9) residents interviewed said that they don’t get their blood pressure checked because they don’t need it. Seven (7) out of nine (9) residents interviewed said that they are provided three (3) meals a day along with snacks. Seven (9) out of (9) residents interviewed revealed that they are satisfied with the services being provided by staff at the facility.

Based on observation, interviews conducted, and a review of records, 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, therefore the allegation is UNSUBSTANTIATED.



Continued on LIC809-C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 11-AS-20241115103623
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: 01/06/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff do not have a background clearance. It is alleged that employees do not have clearance to work at the facility. Based on interviews conducted, eight (8) out of eight (8) staff interviewed stated that they had background clearance before they started working at this facility.

Based on interviews conducted, six (6) out of nine (9) residents interviewed said that they do not know if the employees have background clearance.

The department reviewed the facility's staff roster and compared it to the Facility Personnel Report Summary (LIS536) that was printed on 11/19/24 by the department and revealed that all employees listed on the staff roster provided to the department matched the LIS536 and staff listed had an associate status listed as cleared.

Based on observation, interviews conducted, and a review of records, 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, therefore the allegation is UNSUBSTANTIATED.




An exit interview was conducted with Quality Assurance Director, Melissa Flores and a copy of the report and appeal rights was provided.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 8