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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 01/15/2025
Date Signed: 01/15/2025 03:26:08 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
01/06/2025 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20250106145437
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: 97DATE:
01/15/2025
UNANNOUNCEDTIME BEGAN:
09:21 AM
MET WITH:DIRECTOR MELISSA FLORESTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
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5
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8
9
Staff unable to meet residents care needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
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7
8
9
10
11
12
13
Community Care Licensing Division (CCLD) conducted an unannounced visit to Glen Park at Long Beach Facility on 01/15/2025 and was greeted by Administrator Melissa Flores (S1). CCLD staff explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation.

The investigation consisted of the following: CCLD staff interviewed Administrator (S1), staff (S1-S4), residents (R1-R11). CCLD staff requested and reviewed copies of the following: Physician Report (dated 10/11/2024), incident report (dated 1/1/2025), Needs and Service plan (dated 10/30/2024), Medication Administration Record (MAR) (date 11/1 to 12/31/2024). CCLD staff toured the facility with S1.

The investigation revealed the following:

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
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 2
Control Number 11-AS-20250106145437
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: 01/15/2025
NARRATIVE
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Regarding Allegation #1: Staff unable to meet residents care needs.

It is being alleged that staff was not able to give R1 medications due to staffing issues. CCLD staff toured the facility with S1. CCLD staff noted staff giving medications to residents. CCLD staff noticed staff cleaning and taking care of resident’s needs. CCLD staff reviewed incident report (date 1/1/2025) R1 passed away from health issues. physician report (date 10/11/2024), needs and service plan (date 10/30/2024) for R1. R1 has health issues. 4 out of 4 staff indicate that R1 needs were being met and 4 out of 4 staff indicate that staff was able to meet residents care needs. R1 passed away on 1/1/2025 and could not be interviewed. 2 out of 10 residents indicate that there are staffing issues and staff do not meet residents care needs. 8 out of 10 residents indicate that staff does meet residents care needs.

Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegation of “staff unable to meet residents care needs”, is found to be UNSUBSTANTIATED.



No deficiencies cited during today's visit.

An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Melissa Flores S1.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 01/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2