198602134-12-19-2025-11-AS-UCOL-DPLQVH-20251222113021

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 12/19/2025
Date Signed: 12/19/2025 01:57:32 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, 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 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: 110	DATE:	12/19/2025
		UNANNOUNCED	TIME BEGAN:	12:24 PM
MET WITH:	Executive Director - Jennifer Rivas		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff do not insure an appropriate skilled professional is administering insulin to residents.

INVESTIGATION FINDINGS:

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*This report supersedes the investigation report dated 12/12/2025. A subsequent visit was conducted on 12/19/2025 to update the LIC9099-D. Although this report supersedes the previous report, the complaint investigation findings remain the same.* On 12/19/2025, the department was greeted by the Executive Director, Jennifer Rivas and the purpose of the visit was explained.

On 12/12/2025, 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.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

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 6

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: 12/19/2025

NARRATIVE

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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). On 12/12/2025, a tour of the Medication Room was conducted, interviews were conducted, records were gathered and reviewed. Interviews consisted of R5, R7, R10, Resident 12 (R12) to Resident 14 (R14), Staff 10 (S10), and Witness 3 (W3). R1’s to R15’s records were reviewed which consisted of Medication Administration Records (MARs), Physicians Reports, and Residents that Receives Daily Insulin/Boold Sugar Checks. Facility records reviewed consisted of Personnel Reports, Resident Rosters, Schedule Reports, Staff Training's. Other pertinent records were also reviewed during this investigation.

Investigation revealed the following:

Allegation: “Staff do not ensure an appropriate skilled professional is administering insulin to residents.”

Interviews conducted revealed the following:

On 08/22/2025, W1 indicated that there was no Licensed Vocational Nurse (LVN) in the morning shifts, and a Medical Technician (MedTech) was providing insulin and providing blood sugar checks to residents.
On 08/22/2025, S1 indicated that they are the only LVN in the facility and they work Monday to Friday from 7 AM to 4 PM. Moreover, S1 indicated that recently they started to work weekend shifts. Furthermore, S1 indicated that they “usually make it” to provide residents with their injections and blood sugar checks. S1 was asked what happens when they do not make it and S1 did not answer the question.
On 08/22/2025, S2 indicated that S1 does not come in during the weekends and residents do not receive their injections nor blood sugar checks on the weekends.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 6

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: 12/19/2025

NARRATIVE

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On 08/22/2025, S3 indicated that S1 sometimes comes in during the weekends and sometimes agency LVNs (the facility contracts agency staff when they are short staffed) come in during the weekends but sometimes no LVNs come during the weekends; S3 is not sure what happens when no LVNs come in.
On 08/22/2025, S7 indicated that before there were no LVNs in the facility during the weekends and a MedTech had to come in the facility and provide injections and blood sugar checks to residents.
On 08/25/2025, S8 indicated that they have witnessed MedTech’s provide injections and blood sugar checks to residents. Furthermore, S8 explains that the facility has requested for them to provide injections and blood sugar checks to residents because the LVN was not in the facility, S8 declined and indicated, that day, residents did not receive their injections nor blood sugar checks.
On 12/11/2025, S9 indicated that they have heard of a MedTech providing injections and blood sugar checks to residents.
On 12/12/2025, S10 indicated that on 12/10/2025 an agency LVN did not provide injections nor blood sugar checks to residents.
On 12/12/2025, W3 confirmed that an agency LVN did not provide injections nor blood sugar check to residents. W3 explained that on 12/11/2025 residents informed them that they were upset that they did not receive their insulin injections nor blood sugar checks.

Interviews conducted with R1 to R14 revealed the following: 6 out of 14 residents agreed with the allegation; indicating that there have been days when a MedTech provided them with blood sugar checks and when they did not receive their insulin injection, injection, nor blood sugar check. 6 out of 14 residents are not sure if there have been days when they have missed an injection or blood sugar check. 2 out of 14 residents are certain that a nurse provides them with their medication as required by their physician.

Records reviewed revealed the following:

Personnel Report dated 7/7/2025, indicated that S1’s job title is “LVN”, and their schedule is Monday to Friday from 7:00 AM to 4:00 PM, as well as S1 is the only LVN in the facility.

S1 holds a State of California Board of Vocational Nursing and Psychiatric Technicians License for Vocational Nurse.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 6

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: 12/19/2025

NARRATIVE

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Personnel Report dated 12/09/2025, showed that there is no LVN in the report.

Residents Physician’s Reports revealed the following: Physician’s Reports for R1, R4, R9, R7, R10, R13, R14, and R15 indicated that residents cannot manage their own medication including providing themselves with injections and performing their own glucose testing (blood sugar checks). Physician’s Report for R5 indicated that resident can provide their own injections with assistance, but they are not able to perform their own glucose testing. Physician’s Report for R11 indicated that resident can provide their own injections but requires their insulin dosage to be drawn before self-injections, and they are not able to perform their own glucose testing.

Residents MARs revealed the following: According to R1’s MAR they did not receive their “AM” blood sugar check and insulin injection on 06/02/2025 and 06/19/2025; R1 did not receive their “PM” blood sugar checks and “PM” insulin injections on 05/10/2025, 05/11/2025, 05/17/2025, 05/18/2025, 05/25/2025, 06/07/2025, 06/15/2025, and 07/20/2025. According to R4’s MAR they did not receive their “AM” blood sugar check from 05/03/2025 to 05/31/2025; R4 did not receive their “PM” blood sugar check and insulin injection on 05/10/2025, 05/11/2025, 05/25/2025, 6/7/2025, 06/15/2025, 06/31/2025, and 7/20/2025; R4 did not receive their Ozempic injection on 07/10/2025 and 07/17/2025. According to R5’s MAR they did not receive their “PM” blood sugar checks and “PM” insulin injections on 05/10/2025, 05/11/2025, 05/18/2025, 05/25/2025, 06/07/2025, 06/09/2025, 06/15/2025, and 12/10/2025; R5 did not receive their “PM” insulin injection on 07/20/2025. According to R7’s MAR they did not receive their “AM” blood sugar check and insulin injection on 06/19/2025 and 12/10/2025; R7 did not receive their “PM” blood sugar checks and “PM” insulin injections on 05/10/2025, 05/11/2025, 05/18/2025, 06/07/2025, 06/15/2025, 07/20/2025, and 12/10/2025. According to R8’s MAR they did not receive their “AM” blood sugar check and insulin injection on 06/19/2025. According to R10’s MAR they did not receive their “AM” blood sugar check and insulin injection on 05/27/2025, 06/19/2025, 07/11/2025, and 12/10/2025. According to R12’s MAR they did not receive their 4:00 PM blood sugar check on 12/04/2025 and 12/06/2025; R12 did not receive their 8:00 AM blood sugar check on 12/10/2025. According to R14’s MAR they did not receive their 8:00 AM insulin injection on 12/10/2025.

Schedule Reports revealed the following: From 06/29/2025 to 7/26/2025 and 08/10/2025 to 08/30/2025, S1 is scheduled from 7:00 AM to 4:00 PM and “Open As Needed” on Saturdays and Sundays. From 08/03/2025 to 08/09/2025, S1 was scheduled off.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 6

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: 12/19/2025

NARRATIVE

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S1’s Time Card Reports from 05/01/2025 to 07/31/2025 revealed the following: S1 did not work on 05/10/2025, 06/07/2025, 06/09/2025, and 07/11/2025. S1 did not work in the afternoon and evening of 05/11/2025, 05/18/2025, 06/10/2015, and 07/25/2025. S1 did not work early in the early morning, afternoon and evening time on 05/25/2025. S1 did not work early in the morning and evening of 06/15/2025. S1 did not work from 8:00 AM to 11:59 PM on 06/05/2025. S1 did not work in the morning and afternoon of 07/05/2025.

Observations revealed the following:

Pictures taken in the medication room show that injection needles were improperly discarded. Injection needles were in white trash bags. On 8/22/2025, LPA Leandro toured the medication room and confirmed that said pictures were taken in the facility's medication room.

On 12/12/2025, the medication room’s refrigerator was at 55 degrees Fahrenheit. The refrigerator had insulin medication and other medications that had to be refrigerated at 36 to 46 degrees Fahrenheit. The facilities freezer had a large block of ice on the bottom and a soda inside it next to ice packs. The refrigerator/freezer have a sign that states “Please Do Not Store Food.”

Substantiated: Based on interviews, observations, and records reviewed 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: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 6

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: 12/19/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 12/26/2025 Section Cited CCR 87628(a)	1 2 3 4 5 6 7	Diabetes (a) The licensee shall be permitted to accept or retain a resident who has diabetes if the resident is able to perform his/her own glucose testing with blood or urine specimens, and is able to administer his/her own medication including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	The Executive Director has agreed to ensure that a skilled professional will administer insulin through injections to residents who are unable to perform their own injections.
	8 9 10 11 12 13 14	Based on interviews and records reviewed, the licensee did not comply with the section cited above by not ensuring a skilled professional was administering insulin through injections to residents in care which poses/posed a potential health and safety risk to persons in care.	8 9 10 11 12 13 14	The Executive Director will create a plan to ensure that a skilled professional will be in the facility during the times that residents require their insulin injections. The plan will be emailed to Socorro.Leandro@dss.ca.gov
	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: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 12/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2025

LIC9099 (FAS) - (06/04)

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