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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 09/22/2021
Date Signed: 09/22/2021 06:43:37 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/27/2021 and conducted by Evaluator Jey Cardenas
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20210827103021
FACILITY NAME:GLEN PARK AT LONG BEACHFACILITY NUMBER:
198602134
ADMINISTRATOR:PINK, MARINA EFACILITY TYPE:
740
ADDRESS:1046 E 4TH STTELEPHONE:
(562) 432-7468
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY:208CENSUS: 70DATE:
09/22/2021
UNANNOUNCEDTIME BEGAN:
10:52 AM
MET WITH:Melissa FloresTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not allow resident to have privacy during visit
Staff spoke inappropriately to resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jey Cardenas conducted an unannounced subsequent visit at this facility to continue complaint investigation regarding allegations listed above. LPA conducted a risk assessment, based on the assessment, the facility is clear of Covid-19 infection. LPA Cardenas met with administrator, Melissa Flores and explained the purpose of today's visit.

The investigation consisted of the following: LPA interviewed administrator, Melissa Flores, staff and residents, toured physical plant, and obtained staff/ resident roaster and SIRS for incidents relating to Resident#1 (R1) and Resident#2 (R2), R1's Physician Report, MAR (July-August'21) Emergency ID sheet, Drs orders, Appraisal.

It is alleged that, R1’s Physician came to the facility to perform a monthly exam. S1 walked in and then sat down and "trash talked" R1 to the Physician.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey CardenasTELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
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-20210827103021
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
VISIT DATE: 09/22/2021
NARRATIVE
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Regarding allegation: Staff did not allow resident to have privacy during visit; LPA Cardenas interviewed R1 who indicates that physician came to the facility to perform an exam, they were both in the room and S1 came in and told physicians that resident leaves facility at night and doesn’t return and that S1 brought up the fact that residents ankle was bad. LPA Cardenas interviewed S1, staff said during morning meeting Melissa said that R1's Home Health nurse had concerns regarding residents wound. R1 was not allowing wound to heal by taking the dressing off and applying duct tape around, when the tape was removed there was a skin tear. That same day Physician came to see resident, R1 and physician were in the visitor’s room (106). S1 knocked on the door and asked the physicians if they could talk after, physicians asked S1 to come in, S1 appraised physician about R1s wound for approximately five minutes and then left. LPA interviewed administrator Melisa Flores who indicates that when physicians visit residents they meet in a separate room, the staff will appraise the physician about residents and then leave. Melissa indicates that none of the residents have complained about staff violating resident’s privacy. S2- S6 indicates residents haven’t complained about not getting privacy. During interviews with R2 resident was unable to answer question due to Dementia. R3-R8 indicates staff give them their privacy.

Regarding allegation: Staff spoke inappropriately to resident; During interview with R1, resident indicated that S1 “trashed talked” resident to physician, LPA asked how was staff trash talking, or if any inappropriate language was used, resident didn’t report any. During interview with S1 staff indicated that no inappropriate language was used during that incident, or any other time with R1 or other residents. During interview with administrator Melisa Flores she indicates that staff is professional and conversation S1 had with physician was relevant to the visit. During interviews with staff S2, S3, S4 they indicated that staff do not speak inappropriately to the residents. S2 indicates that staff being stern can be misinterpreted but residents are not spoken to inappropriately. S5 and S6 indicated that some staff could be more professional. During interviews with R2 resident was unable to answer question due to Dementia. R3-R8 indicated that staff is nice, and staff have not spoken inappropriate to them. R8 indicates staff is friendly, and responsive to residents needs.

Based on LPA’s interviews and record reviews, LPA did not find sufficient evidence to support the allegations, Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. Therefore, the allegations are UNSUBSTANTIATED. An exit interview was conducted. A copy of the report to be provided to facility representative Melissa Flores.

SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jey CardenasTELEPHONE: (323) 383-8188
LICENSING EVALUATOR SIGNATURE:

DATE: 09/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3