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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 10/08/2025
Date Signed: 10/08/2025 01:14:56 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
09/19/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20250919141527
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: 101DATE:
10/08/2025
UNANNOUNCEDTIME BEGAN:
09:55 AM
MET WITH:Assistant Administrator - Jennifer RivasTIME COMPLETED:
01:40 PM
ALLEGATION(S):
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Licensee did not follow proper eviction procedures for resident.
INVESTIGATION FINDINGS:
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On 10/08/2025, Licensing Program Analyst (LPA), Socorro Leandro conducted an unannounced subsequent complaint investigation visit regarding the allegation listed above. LPA met with the Assistant Administrator, Jennifer Rivas and the purpose of the visit was explained. LPA was granted entry to the facility.

Investigation consisted of the following: On 09/22/2025, Resident 1 (R1's) records were gathered. On 10/06/2025, R1 and Staff (1) were interviewed and R1’s records were gathered. On 10/07/2025, R1’s records were reviewed which consisted of New Resident Alert; Admission Agreement dated 04/04/2025; Identification and Emergency Information; Thirty Day Notice to Quit dated 05/07/2025; L.A. Superior Court, Long Beach, Eviction Restoration Notice dated 10/06/2025; and emails between the Department and the Facility were reviewed.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
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 3
Control Number 11-AS-20250919141527
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: 10/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
10/09/2025
Section Cited
CCR
87224(a-f)
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87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required.(1) Nonpayment of the rate for basic services within ten days of the due date ...(3) Failure of the resident to comply with general policies of the facility. Said general policies must be in writing, must be for the purpose of making it possible for residents to live together and must be made part of the admission agreement. (4) If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident...(f) A written report of any eviction shall be sent to the licensing agency within five (5) days.

This requirement is not met as evidenced by:
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The Assistant Administrator has agreed to edit R1's Thirty Day Notice to Quit to be in compliance with CCR Eviction Procedures and re-submit it to the department. Once the department reviews the Thirty Day Notice to Quit and indicates that it is within compliance of CCR Eviction Procedures, the facility will be able
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Based on interviews and records review the licensee did not comply with the section cited above in not describing how R1 did not follow the general policies of the facility nor explain how R1 is not an appropriate fit for the facility. Furthermore, the facility did not provide a written report to the department within 5 days of providing an eviction to R1.
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to provide R1 with the updated Thirty Day Notice to Quit. The facility will also, notify the department in writing within 5 days of serving R1 of an eviction.

Email LPA Leandro, LPA Brown, and LPM Hammond.
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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: 10/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250919141527
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: 10/08/2025
NARRATIVE
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Allegation: “Licensee did not follow proper eviction procedures for resident”, it is being alleged that the facility did not follow proper eviction procedures for R1. Interviews conducted revealed the following: According to S1 the facility did follow proper eviction procedures. According to R1 the facility did not follow proper eviction procedures, furthermore, R1 indicated that they do not read or understand the English language, additionally, R1 indicated that they received their Eviction Notice in English and not in their native language. R1’s records reviewed revealed the following: the New Resident Alert states R1 “only speaks Spanish.” The Thirty Day Notice to Quit dated 05/07/2025 indicates that R1 did not follow general policies of the facility [referring to CCR87224(a)(3)] but did not describe how R1 did not follow said general policies of the facility, furthermore, the document indicates that R1 is not an appropriate fit for the facility [referring to CCR87224(a)(4)] but does conducted/provide a reappraisal of R1 as stated in regulation CCR87224(a)(4) and explain how R1 is not an appropriate fit for the facility. Emails, faxes, and mail reviewed from the facility to the department did not demonstrate that the facility provided a written report of an eviction within 5 days to R1. Substantiated: Based on interviews and record reviews, 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 are 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 Assistant Administrator, Jennifer Rivas.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3