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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 07/21/2021
Date Signed: 07/21/2021 03:46:01 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
07/12/2021 and conducted by Evaluator Jade Jordan
COMPLAINT CONTROL NUMBER: 11-AS-20210712160809
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: 74DATE:
07/21/2021
UNANNOUNCEDTIME BEGAN:
09:44 AM
MET WITH:Ghea GuzmanTIME COMPLETED:
09:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not checking on residents in a timely manner
Staff are not meeting residents showering needs
Staff are not ensuring resident eats
Staff are not providing residents water
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 07/21/21 Licensing Program Analyst (LPA) Jade Jordan Conducted a 10 day complaint Visit, regarding the Allegations above. LPA Met with Assistant Administrator Ghea Guzman, And the purpose of the visit was explained.

The Investigation Consisted of 3 staff interviews, and 7 Residents. LPA obtained other Documents pertinent to the investigation such as staff schedule/roster, Resident roster, some individual Physician reports, and needs and services.


Continued On 9099C
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: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
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 3
Control Number 11-AS-20210712160809
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
VISIT DATE: 07/21/2021
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 based on allegation: Staff are not checking on residents in a timely manner.

Resident interview (R) R 1-5 stated that staff are making sure their daily needs are met. Majority of the residents generally stated that staff are doing a good job with checking in with them. Staff 1-3 interviewed stated that they check on their assigned zoned residents within the hour or two. Sometimes Caregiving staff is assigned an extra zone to assist to meet staff coverage needs. LPA Reviewed caregiver zone logs, kept on a monthly basis, and observed caregivers initial documented every two hours of the Resident Zoned rooms that they checked.

Based on LPA interviews, and record review Lpa 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.

The investigation revealed based on the allegation: Staff are not meeting residents showering needs.

Staff interview's revealed that residents in care have showering schedules. 4 Residents concurred that they have a shower schedule, and out of the 4 some require assistance showering. 3 residents stated that they do not need assistance to shower and do so themselves.

Based on LPA interviews, LPA 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.

SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade JordanTELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20210712160809
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
VISIT DATE: 07/21/2021
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 based on the allegation: Staff are not ensuring resident eats

Residents 1-7 all stated that they receive meals and reminders of mealtimes to eat at the facility. Some residents Prefer to eat in their rooms, and some eat downstairs in the dinning room. Staff 1-3 stated that they remind residents of mealtimes and ensure sleeping residents are made aware that meals are being served. Residents have the option to receive meals in their rooms.

Based on LPA interviews, LPA 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.

The investigation revealed based on the allegation: Staff are not providing residents water.

Residents 1-7 all stated that they have access to drinking water in their rooms. 6 Residents indicated that they have water jugs that were provided by the facility. Residents in care generally stated that when they go to the dining hall for mealtime staff will assist them in filling up their water jugs.

Assistant Administrator stated that residents can ask staff to fill them up upon entry of their room, Private cell phone use or Pull chords. All Resident have access to drinking water. LPA also observed drinking fountains within the facility.

Based on LPA interviews, LPA 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

SUPERVISOR'S NAME: Michael CavaTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade JordanTELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3