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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 11/19/2025
Date Signed: 11/19/2025 04:35:52 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
11/14/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20251114164934
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: 108DATE:
11/19/2025
UNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Executive Director - Jennifer RivasTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff refused to change resident's soiled diaper
INVESTIGATION FINDINGS:
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On 11/19/2025, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced complaint investigation visit regarding the allegation listed above. LPA met with the Executive Director Jennifer Rivas, and the purpose of the visit was explained. LPA was granted entry to the facility.

Investigation consisted of the following:

On 11/19/2025, records were gathered, and interviews were conducted. Staff 1 (S1) and Resident 1 (R1) were interviewed. Facility records were reviewed which consisted of Personnel Report dated 11/07/2025, Resident Roster dated 11/18/2025, Staff Schedule from 11/09/2025 to 11/15/2025, R1’s Medical Assessment dated 06/18/2025, R1’s Resident Appraisal dated 07/04/2025.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
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 2
Control Number 11-AS-20251114164934
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: 11/19/2025
NARRATIVE
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The investigation revealed the following:

Allegation: “Staff refused to change resident's soiled diaper”, it is being alleged that facility staff refused to change R1’s soiled diaper. Interview conducted with R1 revealed the following: R1 denied the allegation. Additionally, R1 explained that in the morning of 11/10/2025, facility staff came to their room changed them and got them ready for their medical appointment. Furthermore, R1 left the facility and outside the facility premises had a bowel movement, once R1 arrived at their medical appointment R1 had a soiled diaper. R1 indicates that facility staff do assist with incontinent care needs and have never refused to change their soiled diaper. Interview conducted with S1 revealed the following: S1 indicated that facility staff did not transport R1 to their medical appointment. Based on the department’s interviews and records reviewed this allegation is unsubstantiated. Although the allegation 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.

No deficiencies were cited.

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: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2