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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602134
Report Date: 12/19/2025
Date Signed: 12/19/2025 02:01:03 PM

Document Has Been Signed on 12/19/2025 02:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 BEACHFACILITY NUMBER:
198602134
ADMINISTRATOR/
DIRECTOR:		MICHAEL MENDOZAFACILITY TYPE:
740
ADDRESS:1046 E 4TH STTELEPHONE:
(562) 432-7468
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY: 208CENSUS: 110DATE:
12/19/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:44 PM
MET WITH:Executive Director - Jennifer RivasTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
NARRATIVE
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On 12/19/2025, Licensing Program Analyst (LPA) Socorro Leandro conducted an unannounced complaint investigation visit regarding Complaint Control Number 11-AS-20250722112818. The department observed deficiencies during the course of the investigation and delivered deficiencies to the Executive Director, Jennifer Rivas.

The following deficiencies were observed:

· 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. Interviews with staff and witnesses confirmed that the facility has improperly discarded injection needles.

· On 08/22/2025 and 12/12/2025 one glucometer was observed in the medication room; according to staff and witnesses (on both days) one glucometer is used for all residents who require glucose testing. On 12/12/2025, LPA requested to view extra glucometers but medication room staff was unable to show LPA extra glucometers; staff did not know if the facility had extra glucometers.

· Interviews with staff and witnesses on 08/22/2025 and 12/12/2025 in the medication room confirmed that the facility uses one glucometer for all the residents who require glucose testing.
NAME OF LICENSING PROGRAM MANAGER: Ulysses Coronel
NAME OF LICENSING PROGRAM ANALYST: Socorro Leandro
LICENSING PROGRAM ANALYST 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.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 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 has a sign that states “Please Do Not Store Food.”

· Interviews conducted with staff, residents, and witnesses indicated that a Medical Technician (MedTech) has provided injections and blood sugar checks (glucose testing) to residents.

· Interviews and records reviewed confirmed that residents have not been receiving their medical injections nor glucose testing as prescribed.

· Records reviewed and interviews with residents, staff, and witnesses confirmed that residents who require assistance with glucose testing and injections did receive assistance with hand-over-hand and did not receive their medication/medical care as prescribed.

Deficiencies are being cited based on observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D.

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 .
NAME OF LICENSING PROGRAM MANAGER: Ulysses Coronel
NAME OF LICENSING PROGRAM ANALYST: Socorro Leandro
LICENSING PROGRAM ANALYST 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
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/19/2025 02:01 PM - It Cannot Be Edited


Created By: Socorro Leandro On 12/19/2025 at 12:50 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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
01/15/2026
Section Cited
CCR
87628(b)(1-3)

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Diabetes (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (1) Assisting residents with self-administered medication as specified in Section 87465, Incidental Medical and Dental Care Services. (2) Ensuring that sufficient amounts of medicines, testing equipment, syringes, needles and other supplies are maintained and stored in the facility as specified in Section 87465(c). (3) Ensuring that syringes and needles are disposed of as specified in Section 87303(f)(2).

This requirement is not met as evidenced by:
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The Executive Director has agreed to read Diabetes 87628 (b)(1-3) and create a plan to stay in compliance.

The Executive Director has agreed to train Medical Technicians (MedTechs) on “hand-over-hand.”
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Based on observation, interviews and records reviewed the licensee did not comply with the section cited above in not assisting residents with self-administering medications such as insulin injections and glucose testing with a glucometer, the facility did not ensure that sufficient amounts of testing equipment such as glucometers were in the facility, and the facility has improperly disposed of needles, which poses/posed a potential health, safety or personal rights risk to persons in care.
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The plan and trainings will be emailed to Socorro.Leandro@dss.ca.gov
Type B
01/15/2026
Section Cited
CCR87465(h)(1)(A)

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Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (A) The preservation of medicines requires refrigeration, if the resident has no private refrigerator.

This requirement is not met as evidenced by:
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On 12/12/2025, staff placed a new refrigerator in the medication room
The Executive Director has agreed to create a plan to preserve medication that requires refrigeration, follows medication guidelines and at correct temperature.
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Based on observation and record review the licensee did not comply with the section cited above in not preserving medication as required because the medication that required refrigeration was in a refrigerator that was too hot, the refrigerator was at 55 degrees Fahrenheit and insulin medication and other medications needed to be refrigerated at 36 to 46 degrees Fahrenheit, which poses/posed a potential health, safety or personal rights risk to persons in care.
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The Executive Director has agreed to train staff on said plan.

The plan and trainings will be emailed to Socorro.Leandro@dss.ca.gov
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Ulysses Coronel
NAME OF LICENSING PROGRAM MANAGER:
Socorro Leandro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST 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


LIC809 (FAS) - (06/04)
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