197608506-4-16-2025-31-AS-NMAN-DG8SM8-20250430135931

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 04/16/2025
Date Signed: 04/16/2025 03:40:16 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
09/17/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240917152632

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: 88	DATE:	04/16/2025
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Susan Park		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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The Administrator became resident's payee for SSI payments.
Licensee did not ensure to return resident's SSI checks upon relocation

INVESTIGATION FINDINGS:

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At approximately 11:30 a.m. on 04/16/25 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA Valenzuela conducted an initial visit on 09/26/24 and interviewed staff between 12:00pm and 12:45pm. Today, LPA Reed conducted a record review of pertinent records, including but not limited to a care plan, cash ledgers, a face sheet, and staff and client rosters at 12:00 p.m., toured the facility inside and out at 12:10 p.m., and interviewed staff and residents between 12:15 p.m. and 2:00 p.m.

Regarding the allegation “The Administrator became resident's payee for SSI payments” it was alleged the administrator directly received and handled the monthly Social Security Income (SSI) of Resident #1 (R1). LPA Valenzuela’s interview with the administrator at approximately 12:10 p.m. on 09/26/24 revealed the administrator was never personally R1’s payee for SSI payments or anything other payments.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20240917152632

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST	FACILITY NUMBER: 197608506
	VISIT DATE: 04/16/2025

NARRATIVE

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The money went directly to the facility where the only the Business Office Manager and the administrator handled the funds. Interviews with three (03) staff today revealed the administrator was not a payee for residents, and only the administrator and Business Office Manager handle resident funds. Interviews with eight (08) out of 88 residents who allow the facility to handle their money revealed they have had no issues with the facility handling their money. Interview with Resident #2 (R2) at 1:30 p.m. today revealed they have to wait a few days to receive their money, but they always receive the full amount owed. All nine (09) residents stated the facility is the payee of their SSI and not the administrator. Record Review of R1’s face sheet revealed the administrator was not the payee for R1. Based on record review and interviews, the administrator was not R1’s payee. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Regarding the allegation “Licensee did not ensure to return resident's SSI checks upon relocation” it was alleged that from December 2023 to April 2024, the licensee received R1’s SSI payments without returning them. Interview with the administrator at 12:15 p.m. today revealed all of R1’s SSI funds were properly returned to the Social Security Administration. Record review of banking and SSI documents revealed the facility returned all SSI funds belonging to R1 from December 2023 to April 2024 on 04/19/24. Review of check photocopies at 1:45 p.m. today confirmed a check was issued from the facility to the Social Security Administration in the full amount owed on 04/19/24. Based on record review and interviews, the licensee ensured R1’s SSI checks were returned. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

During today’s inspection, no immediate health or safety concerns were observed.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 04/16/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2025

LIC9099 (FAS) - (06/04)

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