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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608505
Report Date: 06/17/2025
Date Signed: 06/17/2025 02:25:00 PM

Document Has Been Signed on 06/17/2025 02:25 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:GLEN PARK AT GLENDALE - BOYNTON STFACILITY NUMBER:
197608505
ADMINISTRATOR/
DIRECTOR:		SUSAN PARKFACILITY TYPE:
740
ADDRESS:1250 BOYNTON STTELEPHONE:
(818) 246-9000
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY: 98CENSUS: 65DATE:
06/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:47 AM
MET WITH:Susan Park, AdminisitratorTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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At 9:47 AM, Licensing Program Analysts (LPAs) Huma Rahimi and Leslie Ngo-Castaneda conducted an unannounced annual inspection to the above facility. LPAs were greeted at the front desk and met with the Administrator Susan Park. LPAs explained the reason for the visit. LPAs and the Administrator toured the facility inside and out and observed the following:
The Administrator had to leave and the General Manager Brenda Chacon was designated to sign today's report.

The facility is a single story building with private and shared bedrooms, private bathrooms, kitchen, dining room, recreation room, common area, patios, and outdoor areas. The facility is licensed for 98 residents ages 60 and over. The fire clearance is approved for 98 non- ambulatory residents of which 15 can be . There is a hospice waiver approved for 10 residents.

Bedrooms: LPAs and Administrator toured vacant and occupied bedrooms. Rooms # 46, 50, 80, 47 28, 38, and 22 were inspected. LPAs observed lamps, nightstands, beds, linens, and private bathrooms with liquid soap, hand towels, and trash cans.

Bathrooms: The facility currently has two common restrooms. Additionally, staff has their own private bathrooms. The bathroom was sanitary with liquid soap, paper towels, handwashing instruction sign, and a trash can with a tight-fitting lid. At 9:55 AM, LPAs measured the hot water temperature of a private resident bathroom in room #46 to be 106.3F.

Common Areas: All floors, walls, and ceilings were clean. Furniture in the dining room, lounges, living room, and activity room were clean and in good repair. At 10:00 AM LPAs measured the room temperature to be 72 F. Continue on LIC 809C

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Huma Rahimi
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2025
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT GLENDALE - BOYNTON ST
FACILITY NUMBER: 197608505
VISIT DATE: 06/17/2025
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Outdoor Space: LPAs and Administrator toured the outside space. LPAs observed two shaded areas with enough outdoor furniture which was observed in a good condition.

LPAs tested the facility's emergency exit doors and observed that the emergency exit requires an access code to exit out to the back of the facility. Both exit doors were functional and operational. LPAs also observed two main exits in the back of the facility to be free of any obstruction and hazard.

Laundry: LPAs observed a laundry room to be locked and inaccessible to residents in care. All detergents were locked inside the laundry room. LPAs observed the washer and dryer actively working and in a good working condition.

Medication Room: LPAs observed a locked Medication Room where all the residents medication were kept and supervised by a Med Tech. LPAs reviewed random residents medication and did not observe any discrepancies.

Storage: LPAs observed a storage room in the basement which has an access through the facility kitchen. LPAs observed that the storage room to be locked and inaccessible to residents in care. Additional emergency supplies and kitchen supplies closets were observed in the hallway by room #50. They were also observed locked and inaccessible to residents in care.

Kitchen: LPAs observed menus outside of the kitchen in the dining room. Menus applied to typical and diabetic diets. The kitchen floors and surfaces were clean, and all food was sealed and labeled. The dining room contained tables with designated seating for the residents.

Fire Safety: LPAs observed that the facility has fire extinguishers in every wing of the facility and were last serviced on 08/15/2024. All fire extinguishers were fully charged. At 2:05 PM, LPAs reviewed the most recent fire safety report from Atlantic Electric Company conducted on 03/17/2025. All systems were functional and passed inspection.

At 11:10 AM LPAs tested the call system in Room #55 to be functional. Staff responded to the call within eight and half minutes.

Between 11:30 AM to 2:00 PM, LPAs reviewed records of eight (8) residents and four (4) staff. Resident and staff records appeared to be complete and updated.

No deficiency cited during today’s visit. Exit interview conducted and copy of this report signed and delivered.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Huma Rahimi
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
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