197608506-12-18-2024-31-AS-NMAN-DFJUSC-20250408155003

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 12/18/2024
Date Signed: 12/18/2024 12:53:55 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
12/10/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20241210123911

FACILITY NAME:	GLEN PARK AT GLENDALE - MARIPOSA ST		FACILITY NUMBER:	197608506
ADMINISTRATOR:	SUSAN PARK		FACILITY TYPE:	740
ADDRESS:	1220 S MARIPOSA ST		TELEPHONE:	(818) 242-9000
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	120	CENSUS: 92	DATE:	12/18/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Susan Park		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Residents room smells malodorous.
Staff do not answer residents calls for assistance timely.
Staff are not ensuring resident's room is cleaned properly.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma 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.

---Residents room smells malodorous.

It was alleged that residents’ rooms smell bad and smells like roach spray. To investigate the allegation, LPA conducted a physical plant tour at around 9:30a.m., interviewed four staff from 10:30a.m. to 11:30a.m. and nine (09) residents from around 11:30a.m. – 1:00p.m. During the physical plant tour, LPA did not experience any malodor or roach spray odor. During interviews with staff, all staff stated residents’ rooms do not consistently have malodor or smell of roach spray.
(CONT on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024

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 4

Control Number 31-AS-20241210123911

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: 12/18/2024

NARRATIVE

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During interviews with residents, one (01) out of nine (09) residents stated room had a bad smell and smelled of insect spray but that now everything is okay as they move to another room. All other residents stated they do not experience malodor in the facility.

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

------Staff do not answer residents calls for assistance timely.

It was alleged that staff does not answer the call for the resident’s pull cord. To investigate the allegation, LPA conducted a physical plant tour at around 9:30a.m., interviewed four staff from 10:30a.m. to 11:30a.m. and nine (09) residents from around 11:30a.m. – 1:00p.m. During the physical plant tour, LPA selected five (05) rooms at random and observed an average response time of six (06) minutes. During interviews with staff, all staff stated they respond to the call button within five (05) to ten (10) minutes. During interviews with residents, three (03) out of nine (09) residents stated staff respond within ten (10) to fifteen (15) minutes. All other residents stated staff respond with five (05) to ten (10).

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

---Staff are not ensuring resident's room is cleaned properly.

It was alleged that resident had an accident on the floor and the staff did not ensure that they cleaned it up properly. To investigate the allegation, LPA conducted a physical plant tour at around 9:30a.m., interviewed four staff from 10:30a.m. to 11:30a.m. and nine (09) residents from around 11:30a.m. – 1:00p.m. During the physical plant tour, LPA did not observe any stains on the carpet of Resident #1’s (R1) old room or any other room. During interviews with staff, all staff stated R1’s carpet was shampooed and vacuumed and that it was cleaned right away. Staff #1 (S1) added that they tried removing the carpet to install vinyl but that the store was out of stock. S1 also stated R1 was moved to a room without carpeting as soon as one became available.

(CONT. on LIC9099-C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 12/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 31-AS-20241210123911

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: 12/18/2024

NARRATIVE

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During interviews with residents, one (01) out of nine (09) residents stated staff does not clean the room properly. All other residents stated they feel staff does a good job of keeping their rooms clean.

Based on interviews and observations, 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: 12/18/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024

LIC9099 (FAS) - (06/04)

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