198602134-5-12-2025-11-AS-RORN-DHRMW4-20250618095743

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 05/12/2025
Date Signed: 05/12/2025 03:39:10 PM

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
04/18/2025 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20250418141748

FACILITY NAME:	GLEN PARK AT LONG BEACH		FACILITY NUMBER:	198602134
ADMINISTRATOR:	MICHAEL MENDOZA		FACILITY TYPE:	740
ADDRESS:	1046 E 4TH ST		TELEPHONE:	(562) 432-7468
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	208	CENSUS: 94	DATE:	05/12/2025
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Assistant Administrator Cathrine Dacara		TIME COMPLETED:	03:46 PM

ALLEGATION(S):

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Staff illegally evicted resident in care.

INVESTIGATION FINDINGS:

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On 05/12/25, Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit regarding the allegation above. LPA Villegas met with the Assistant Administrator Cathrine Dacara as the purpose of te visit was explained.

Investigation Consisted of the following: On 04/24/25, LPA Richard conducted the following interviews: Administrator (A1), Executive Director (S1), Licensed Vocational Nurse (S2), Office Manager (S3), and Resident’s #2-5 (R2-R5). LPA Richards obtained and reviewed the following documents: Resident’s roster, Personnel roster, (R1) Identification and Emergency Information, Physicians Report, Medication Mar (MAR), Needs of Service Plan, Resident Appraisal (dated 04/02/25) and Patient Pogress notes (dated 03/26/25 to 04/02/25). On 5/12/25 at 11am LPA Villegas conducted second interview with A1 and from 11:30am- 1pm LPA Villegas conducted interviews with R6-R9. On 05/12/25 LPA conducted a file review for R1.

The investigation revealed the following:

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

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 3

Control Number 11-AS-20250418141748

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: 05/12/2025

NARRATIVE

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Allegation: Staff illegally evicted resident in care.

It is being alleged that Glen Park at Long Beach would not readmitted resident after resident was discharged from the hospital. On 04/24/25 and 05/12/25 interviews were conducted with R2-R9 regarding the allegation above, 8 of 8 residents interviewed denied the allegation above. Resident #1 (R1) was not interviewed as R1 is no longer receiving care at Glen Park at Long Beach. On 4/24/25 LPA Richard conducted interviews with S1-S3 regarding the allegation above, 3 of 3 staff interviewed denied the allegation above and reported that resident was not evicted as it was determined upon reassessment that resident needed a hire level of care. On 04/24/25 and 05/12/25 interviews were conducted with A1 regarding the allegation above, A1 denied the allegation above and reported that upon reassessment of R1, it was determined that the facility could not meet R1's needs as R1 requires a higher level of care. On 05/12/25 LPA Villegas conducted a file review for R1, per admission agreement, R1 was admitted to Glen Park at Long Beach on 03/26/24, on Physicians Report dated: 3/11/2024, and Needs of Service Plan dated:10/26/2024 it is indicated that R1 has Schizophrenia. On unusual incident report dated 03/28/25 it is reported that R1 was placed on a 5150 on 3/25/25, on resident appraisal dated 04/02/25 it is indicated that R1 needs mental health attention. LPA Villegas did not observe any record confirming that an incident report was sent to CCLD communicating that R1 was hospitalized 03/25/25.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8) are being cited on the attached LIC 9099D.

Exit interview conducted, appeal rights explained, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250418141748

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: 05/12/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/26/2025 Section Cited CCR 87224(a)(4)	1 2 3 4 5 6 7	The licensee may evict a resident for one or more of the reasons... (30) days written notice to the resident is required except...If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant... and the licensee and the person	1 2 3 4 5 6 7	The licensee and executive director will review title 22 eviction regulations and submit a statement acknowleding the review and acknowledge the understanding of title 22 regulations. Licensee and executive director to submit a written plan detailing how facility will get into complaince of title 22 regulations.
	8 9 10 11 12 13 14	who performs the reappraisal believe that the facility is not appropriate for the resident. Based on interviews and record review the licensee did not comply with the section cited above as there was no indication that there was significant change in R1, R1 did not have a need that was not previously identified. which poses a health and safety risk to residents in care.	8 9 10 11 12 13 14	Plan to be submitted to LPA by POC due date.
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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: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2025

LIC9099 (FAS) - (06/04)

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