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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 12:20:24 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
02/19/2025 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20250219143528
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:
09:04 AM
MET WITH:Quality Assurance Director Rafeal SilvaTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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9
Staff did not provide clients medical records in a timely manner.
INVESTIGATION FINDINGS:
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On 02/27/25 at 9am Licensing program analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Quality Assurance Director Rafeal Silvas the purpose of the visit was explained.

The investigation consisted of the following: On 02/27/25 LPA Villegas obtained a copy of the following documents: staff roster, resident rosters, list of residents obtaining services from PACE/Welbe health,and identification and emergency information form for residents #1-13 (R1-R13). On 02/27/25 between 9:10am- 10:30am LPA conducted interviews with residents #1-7 (R1-R7), and between 10:30am- 10: 50am LPA Villegas conducted interviews with staff #1-2 (S1-S2).

The investigation revealed the following:
Allegation: Staff did not provide clients medical records in a timely manner.
It is being alleged that copies of Medication Administration Records are not being provided in a timely manner when requested. There were no residents identified in nitial report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
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 2
Control Number 11-AS-20250219143528
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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On 02/27/25 between 9:10am- 10:30am LPA conducted interviews with residents #1-7 (R1-R7) regarding the allegation above, 7 of 7 residents interviewed denied the allegation above. On 02/27/25 between 10:30am- 10:50 am am LPA Villegas conducted interviews with staff #1-2 (S1-S2), 2 of 2 staff denied the allegation above and reported copies of medication administration records are provided when requested, copies of records can take 2-5 days to generate. On 02/27/25 LPA did not observed any evidence that any request was made by a resident or responsible party.

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 Quality Assurance Director Rafeal Silvas, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
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 2