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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 12/11/2025
Date Signed: 12/11/2025 04:30:51 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, 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
07/22/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20250722112818
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: 110DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Executive Director - Jennifer RivasTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff do not ensure residents are cleaned properly.
INVESTIGATION FINDINGS:
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On 12/11/2025, Licensing Program Analyst (LPA) Socorro Leandro conducted a subsequent complaint investigation visit regarding the allegation listed above. LPA met with the Executive Director, Jennifer Rivas and the purpose of the visit was explained. The LPA was allowed entry to the facility.

The investigation consisted of the following:

On 07/24/2025, facility records were gathered. On 08/22/2025, a tour of the facility was conducted, interviews were conducted, and facility records were gathered. A tour of the facility consisted of the medication room and kitchen. Interviews consisted of Witness 1 (W1), Resident 1 (R1) to Resident (6), and Staff 1 (S1) to Staff (7). On 08/25/2025, Staff 8 (S8) was interviewed. On 12/11/2025, interviews were conducted, records were gathered and reviewed. Interviews consisted of Witness 2 (W2), Resident 7 (R7) to Resident 11 (R11), and Staff 9 (S9).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
07/22/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20250722112818

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: 110DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Executive Director - Jennifer Rivas TIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
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8
9
Staff do not ensure food is stored properly.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/11/2025, Licensing Program Analyst (LPA) Socorro Leandro conducted a subsequent complaint investigation visit regarding the allegation listed above. LPA met with the Executive Director, Jennifer Rivas and the purpose of the visit was explained. The LPA was allowed entry to the facility.

The investigation consisted of the following:

On 07/24/2025, facility records were gathered. On 08/22/2025, a tour of the facility was conducted, interviews were conducted, and facility records were gathered. A tour of the facility consisted of the medication room and kitchen. Interviews consisted of Witness 1 (W1), Resident 1 (R1) to Resident (6), and Staff 1 (S1) to Staff (7). On 08/25/2025, Staff 8 (S8) was interviewed. On 12/11/2025, interviews were conducted, records were gathered and reviewed. Interviews consisted of Witness 2 (W2), Resident 7 (R7) to Resident 11 (R11), and Staff 9 (S9).
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20250722112818
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
VISIT DATE: 12/11/2025
NARRATIVE
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Investigation revealed the following:

Allegation: “Staff do not ensure food is stored properly”, it is being alleged that the facility food is not of good quality and not stored properly. On 08/22/2025, a kitchen tour was conducted, and the following was observed: at 12:04 PM LPA Leandro took a picture of mashed potatoes on a paper plate without a cover (e.g. plastic wrap) inside the refrigerator; at 12:04 PM LPA Leandro took a picture of a cotton cleaning towel inside the refrigerator; at 12:05 PM LPA Leandro took a picture of strawberries with mold on them inside the refrigerator, the mold was fuzzy with green and white; at 12:06 PM LPA Leandro took a pictures of sweet potatoes with mold on them inside the refrigerator, the mold was fuzzy with green and white; at 12:06 PM LPA took a pictures of tomatoes with mold on them inside the refrigerator, the mold was black and fuzzy; (facility staff discarded said produce). Substantiated: Based on observations the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 is being cited on the attached LIC 9099D.

An exit interview was conducted, Plans of Corrections were reviewed and developed. A copy of this report and appeal rights were discussed and left with the Executive Director, Jennifer Rivas.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20250722112818
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/23/2025
Section Cited
CCR
87555(b)(8)(9)(28)
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General Food Service Requirements (b) The following food service requirements shall apply: (8) All food shall be of good quality. Commercial foods shall be approved by appropriate federal, state and local authorities. Food in damaged containers shall not be accepted, used or retained. (9) Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service. (28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery.

This requirement is not met as evidenced by:
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The Executive Director has agreed to read California Code of Regulations (CCR) General Food Service Requirements and create a plan to follow said regulations. The Executive Director has agreed to include in the plan: daily observation of food and discard food if it is not of good quality,...
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Based on observation the licensee did not comply with the section cited above in not having all food of good quality, not having all food in storage, and not protecting food from contamination, which poses/posed a potential health, safety or personal rights risk to persons in care.
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properly store food, and protect all food from contamination. The Executive Director has agreed to retrain kitchen staff.

Email proof of correction to Socorro.Leandro@dss.ca.gov
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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: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 11-AS-20250722112818
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
VISIT DATE: 12/11/2025
NARRATIVE
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Investigation revealed the following:

Allegation: “Staff do not ensure residents are cleaned properly”, it is being alleged that staff refuse to provide residents with showers. Interviews conducted with R1 to R11 revealed the following: 10 out of 11 residents denied the allegation and 1 out of 11 residents agreed with the allegation. Interviews conducted with S1 to S9 revealed the following: 9 out of 9 staff denied the allegation. Interviews conducted with W1 to W2 revealed the following: 1 out of 2 witnesses denied the allegation and 1 out of 2 witnesses did not know if said allegation did or did not occur. Records reviewed of Shower Schedules from 05/01/2025 to 07/25/2025 indicates that staff: “assist” residents with showers, “stand by” when residents showers, and “remind” residents to shower. 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.

An exit interview was conducted, and a copy of this report was left with the Executive Director, Jennifer Rivas.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5