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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 10/17/2024
Date Signed: 10/17/2024 03:30:31 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2024 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20241015110335
FACILITY NAME:GLEN PARK AT GLENDALE - MARIPOSA STFACILITY NUMBER:
197608506
ADMINISTRATOR:SUSAN PARKFACILITY TYPE:
740
ADDRESS:1220 S MARIPOSA STTELEPHONE:
(818) 242-9000
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:120CENSUS: 94DATE:
10/17/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Susan ParkTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff are not preventing resident from engaging in inappropriate behavior(s) in the presence of other residents in care.
Staff are not preventing resident from harassing other residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Abeye Duguma and Angelica Segovia conducted an initial complaint visit to the facility to investigate the above allegations. LPAs met with Executive Director, Susan Park, and explained the reason for the visit.

--- Staff are not preventing resident from engaging in inappropriate behavior(s) in the presence of other residents in care.

It was alleged that Resident #2 (R2) exposes themselves by not wearing clothes from the waist down. To investigate the allegations, LPAs conducted a physical plant tour at around 10:00a.m. and interviewed four (04) staff and nine (09) residents from around 11:00a.m. to 1:30p.m. During interviews with staff, Staff #4 (S4) stated they witnessed R2 exposed in the hallway after exiting the communal shower. All other staff stated that R2 does not exposes themselves from the waist down to other residents.
(CONT. LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
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 31-AS-20241015110335
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST
FACILITY NUMBER: 197608506
VISIT DATE: 10/17/2024
NARRATIVE
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During interviews with residents, Resident #1 (R1) stated that R2 inappropriately exposes themselves. All other residents stated that they have never witnessed R2 exposing themselves from the waist down.

Based on observations and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff are not preventing resident from harassing other residents in care.

It was alleged that R2 calls people socialist, Marxist, communist and makes trouble for everyone. To investigate the allegations, LPAs interviewed four (04) staff and nine (09) residents from around 11:00a.m. to 1:30p.m. During interviews with staff, all staff stated that R2 calls staff socialist and Marxist but does not make trouble for resident. During interviews with residents, R1 stated that R2 calls them socialist and Marxist and makes trouble. All other residents stated residents do not make trouble or call them socialist and Marxist.

Based on the interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards were noted during the visit.

Exit interview was conducted and a copy of the report was issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 10/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2024
LIC9099 (FAS) - (06/04)
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