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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 02/27/2025
Date Signed: 02/27/2025 12:29:12 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
12/11/2024 and conducted by Evaluator Zina Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241211135609
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: 94DATE:
02/27/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Rafeal Silva, Quality Assurance DirectorTIME COMPLETED:
12:28 PM
ALLEGATION(S):
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Licensee does not ensure facility is adequately staffed to meet resident's needs.
Staff are not properly trained.
Staff did not properly assess residents prior to admission.
INVESTIGATION FINDINGS:
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On 02/27/2024 at 9:45 am, Licensing Program Analyst (LPA) Zina Brown and Licensing Program Manager (LPM) Janae Hammond conducted a subsequent visit in order to deliver investigation findings. LPA/LPM met with Rafeal Silva, Quality Assurance Director and explained the purpose of the visit .

The investigation consisted of the following: On 12/16/2024 LPA Brown interviewed the Administrator (A1), Staff #2 - Staff #6 (S2 - S6) and Resident # 1 - Resident #9 (R1 – R9). LPA requested resident/staff Roster, resident files for Resident #1 - Resident #9 (R1 - R9) such as LIC 601 / Pre-Placement Appraisal/ Functional Capability Assessment/Medication List/ Admission Agreement/ Physician Report, proof of Staff Training (med-tech/caregiver) – Initial Training and ongoing training, timecards for staff (October 2024 – December 2024), list of incontinence residents. On 1/21/25 at 2:48pm LPA interviewed Staff #1. On 1/21/24 at 8:47am LPA interviewed Resident #10. On 1/24/25 at 9:05am LPA/LPM interviewed Staff #7.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
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 4
Control Number 11-AS-20241211135609
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: 02/27/2025
NARRATIVE
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The investigation revealed the following:

Allegation: Licensee does not ensure facility is adequately staffed to meet resident's needs.
It was alleged that the facility is not meeting the resident’s needs adequately due to the facility not being adequately staffed.


On 12/16/2024 at 9:45am, LPA/LPM interviewed the Administrator Melissa Flores regarding the allegation. A1 states the facility has about 34 staff and is adequately staff even with the agency that the facility uses.

On 12/16/2024 between 11:45am - 1:00 pm, 1/21/25 2:48pm and 1/24/25 at 9:05 am, LPA/LPM interviewed Staff #1-7 regarding the allegation; 3 out of 7 staff confirmed the allegation facility is not adequately staffed, 4 out of 7 staff denied the allegation and feel the facility is adequately staffed.

On 12/16/2024 between 10:00am - 11:30am and 1/21/2025 8:47am-9:38am, LPA/LPM interviewed Residents #1-10. 4 out of 10 residents confirmed the allegation; 6 out of 10 residents denied the allegation. LPA reviewed and observed on the Personnel Report LIC 500 and Timesheets Personnel Report that the following 10 Care Partners, 3 Med Techs (who work as Care Partners as well), 1 LVN, 1 Executive Director, 1 Office Manager, 1 Intake Coordinator, 2 Front Desk Staff, 2 Activity Director, 6 Housekeepers, 1 Maintenance Staff (who also serves as a medtech as well). The facility also utilizes a Home Care Organization,

Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be unsubstantiated.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20241211135609
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: 02/27/2025
NARRATIVE
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Allegation: Staff are not properly trained
It was alleged that the facility has not properly trained their staff. On 12/16/2024 at 9:45am, LPA/LPM interviewed the Administrator Melissa Flores regarding the allegation. A1 denied the allegation as she states the training process consist of the use of care and compliance for 40 hours of annual training, video training (20 hours), onboard training (30 days) and continued training as needed (8 hours on site).

On 12/16/2024 between 11:45am - 1:00 pm, 1/21/25 2:48pm and 1/24/25 at 9:05 am, LPA/LPM interviewed Staff #1-7 regarding the allegation, 6 out of 7 staff interviewed denied the allegation; 1 out of 7 staff did not answer the question. On 12/16/2024 between 10:00am-11:30am and 1/21/2025 8:47am-9:38am, LPA/LPM interviewed Residents #1-10. 4 out of 10 residents interviewed confirmed the allegation; 6 out of 10 residents denied the allegation.

On 12/19/2024, LPA received documented staff training conducted in 2024 and observed the following training completed for 9 out 9 staff: new employee 20 hour video training, OSHA Bloodborne Pathogen Training 30 Mins, Basic Medication Training, Medication Technician (8 Hours), Annual Training (2 Hours) 4 Quarter Dementia Topics: Dementia Care: Aggressive Behaviors, Therapeutic Interventions, California Medication Regulations, Workplace Violence and Home Care Organization.

Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be unsubstantiated.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20241211135609
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: 02/27/2025
NARRATIVE
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Allegation: Staff did not properly assess residents prior to admission.

It was alleged that the facility does not conduct a pre placement assessment of residents prior to them being admitted to the facility. On 12/16/2024 at 9:45am, LPA/LPM interviewed the Administrator Melissa Flores regarding the allegation. A1 denied the allegation of residents not being assessed prior to admission.

On 12/16/2024 between 11:45am -1:00 pm, 1/21/25 2:48pm and 1/24/25 a, LPA/LPM interviewed staff regarding the allegation; 5 out of 6 staff interviewed denied the allegation; 1 out of 6 staff interviewed were unable to answer the question.

On 12/16/2024 between 10:00am -11:30am and 1/21/2025 8:47am-9:38am LPA/LPM interviewed residents #1-10 regarding the allegation 8 out of 10 residents interview denied the allegation; 1 out of 10 residents confirmed the allegation; 1 out of 10 residents was unable to answer the question.

LPA conducted a file review of 10 resident records. 10 of 10 records reviewed contained proper admission documents.

Based on the records reviewed, interviews conducted and Observations the allegations are Unsubstantiated: Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.


Exit interview conducted with Rafeal Silva, Quality Assurance Director and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/27/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4