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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 08/21/2025
Date Signed: 08/21/2025 02:40:01 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
07/21/2025 and conducted by Evaluator Jose Anguiano
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250721120311
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: 91DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
01:21 PM
MET WITH:Catherine DacaraTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are mismanaging residents medication.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/21/2025 Licensing Program Analyst (LPA) Jose Anguiano conducted a subsequent visit to deliver findings regarding the above allegations. LPA met with the Assistant Administrator Catherine Dacara and the purpose of the visit was explained.

Investigation consisted of the following: On 07/25/2025, around 8:00AM LPA Anguiano toured the facility, interviewed (9) staff members (S1–S9), interviewed (11) residents (R1-R11) and conducted record reviews of facility, staff and resident’s records. On 08/06/2025 LPA interviewed (3) staff members (S1-S3), and acquired staff (S6) training records.

Investigation revealed the following: Regarding the allegation “Staff are mismanaging residents’ medication” it is being alleged that medications are not being given to residents per doctors’ orders. Interviews conducted revealed the following: 9 out of the 11 residents did not agree with the allegation, and 2 out of the 11 residents agreed with the allegation.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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 5
Control Number 11-AS-20250721120311
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: 08/21/2025
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
9 out of the 9 staff members did not agree with the allegation. Although S1 stated that the facility has a system in place to ensure that medications are given to residents in care, S1-S5 were not able to explain why the medications for S1-S3 were unaccounted for. LPA observations revealed the following: On 07/25/2025, R1-R3 residents bubble pack medications were popped on incorrect days with no document to explain the reasons. R1 and R2’s medication for 07/26/2025 and R3’s medication for 07/31/2025 were unaccounted for without documentation or explanation. Records review revealed the following: The July 2025 medication administration records (MAR) for R1-R2 did not indicate that R1 and R2’s medication for 07/26/2025 and R3’s medication for 07/31/2025 were given. Based on interviews, observation and records reviews the preponderance of evidence standard has been met. Therefore, the above allegation is found to be Substantiated. California Code of Regulations, Title twenty-two (22), Division six (6), is being cited, please see attached LIC-9099D. A Civil penalty is being assessed for repeat violation please see LIC421RP.

An exit interview was conducted, plans of corrections were developed and appeals rights were provided to Catherine Dacara.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20250721120311
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: 08/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/21/2025
Section Cited
HSC
87465(h)(6)(A-F)
1
2
3
4
5
6
7
Incidental Medical and Dental Care. The following...shall apply to medications...stored: The licensee shall be responsible for assuring that a record of...medications for each resident is maintained...medication. This requirement was not met as evidence by:
1
2
3
4
5
6
7
The licensee agreed to create a plan to have all staff giving medications recount all the residents’ routine & PRN medications by the end of their shift. All staff assisting residents with medication to be re-trained by a licensed professional pharmacist.
8
9
10
11
12
13
14
Based on observation and record review, the licensee did not comply with the section cited above,On 07/25/2025, 3 out of 3 resident medications were missing and unaccounted for this poses/posed a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14
Proof of correction to be submitted to the department via email Jose.anguiano@dss.ca.gov by POC due date.
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
07/21/2025 and conducted by Evaluator Jose Anguiano
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250721120311

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: 91DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
01:21 PM
MET WITH:Catherine DacaraTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unqualified staff operating the facility.
Staff did not treat residents with dignity and respect.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 08/21/2025 Licensing Program Analyst (LPA) Jose Anguiano conducted a subsequent visit to deliver findings regarding the above allegations. LPA met with the Executive Director Catherine Dacara and the purpose of the visit was explained.

Investigation consisted of the following: On 07/25/2025, around 8:00AM LPA Anguiano toured the facility, interviewed (9) staff members (S1–S9), interviewed (11) residents (R1-R11) and conducted record reviews of facility, staff and resident’s records. On 08/06/2025 the LPA interviewed (3) staff members (S1-S3) and acquired staff (S6) training records.

Investigation revealed the following: Regarding the allegation "Unqualified staff operating the facility" it is being alleged that staff that are giving medications are not qualified to do so.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20250721120311
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: 08/21/2025
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
Interviews conducted revealed the following: 10 out of the 11 residents did not agree with the allegation, and 1 out of the 11 residents agreed with the allegation. 9 out of the 9 staff members did not agree with the allegation, S1 said that all staff that give medication need to attend a course, pass a test, and shadow other Medtech’s before allowed to give medications to residents. LPA observations revealed the following: On 07/25/2025 and 08/06/2025 LPA observed Medtech’s S1-S4 administering medication to residents. Records review revealed the following: S1-S6 all had certificate of completion of Basic Medication Training Course in staff records. Based on the evidence gathered, interviews conducted, and records reviewed, although the allegation "Unqualified staff operating the facility" may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Investigation revealed the following: Regarding the allegation "Staff did not treat residents with dignity and respect" it is being alleged that staff are yelling and using profanity when talking to residents. Interviews conducted revealed the following: 10 out of the 11 residents did not agree with the allegation, and 1 out of the 11 residents agreed with the allegation. 9 out of the 9 staff members did not agree with the allegation, S1 said that all residents are treated like family and are respected. LPA observations revealed the following: On 07/25/2025 and 08/06/2025 LPA observed staff treating residents respectfully. Based on interviews conducted and LPA observations, although the allegation "Staff did not treat residents with dignity and respect " may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and appeals rights were provided to Catherine Dacara.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5