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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 05/13/2025
Date Signed: 05/13/2025 02:46:09 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 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
02/07/2025 and conducted by Evaluator Evelin Rios
COMPLAINT CONTROL NUMBER: 31-AS-20250207131924
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: 87DATE:
05/13/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Susan Park / Executive DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff do not provide adequate supervision to residents.
INVESTIGATION FINDINGS:
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On 05/13/2025 Licensing Program Analyst (LPA) Evelin Rios conducted an unannounced subsequent complaint visit to the facility to investigate the above allegation. LPA met with Executive Director (ED), Susan Park. LPA explained the reason for the visit. An entrance interview was conducted. LPA requested copies of the resident roster and personnel report.

At 12:03 p.m., LPA Rios conducted a physical plant tour of the facility with the ED. From approximately 12:13 p.m., to 1:50 p.m., LPA Rios interviewed ten (10) residents or 10% of the facility’s census.

Allegation: Staff do not provide adequate supervision to residents. Regarding the allegation it was reported that staff did not realize a resident that required supervision exited the facility unattended and was returned to the facility by the local police department. To investigate the allegation LPA Rios conducted an initial complaint visit on 02/14/2025. During the initial visit LPA conducted a physical plant tour. (Continue to LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
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-20250207131924
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT GLENDALE - MARIPOSA ST
FACILITY NUMBER: 197608506
VISIT DATE: 05/13/2025
NARRATIVE
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(Continued from LIC9099)
Delayed egress exit doors were inspected by LPA Rios. LPA observed, each door required several seconds of pressing before they opened, and the alarm sounded on all attempts. Subsequently, the ED and LPA proceeded to the reception area to observe the camera video stream. The ED explained that when the door is activated, the camera feed switches to focus solely on that door. LPA did not observe any operational concerns with the doors. LPA attempted to review video footage from the day in question. Footage was not saved. LPA's review of fire clearance confirmed, the facility is approved for a secured perimeter.

On 02/14/2025 LPA Rios did the following: From 11:18 a.m. to 11:50 a.m., LPA interviewed three (03) staff that were present during the afternoon shift on 02/04/25. LPA also interviewed the ED who was not present when the incident took place. At 11:51 a.m., LPA interviewed resident #1's (R1's) Responsible Party via telephone and at 12:22 p.m., LPA interviewed, staff #1 (S1) via telephone. At 12:45 p.m. LPA reviewed and obtained copies of R1's file, such as their Physician’s Report, Functional Capabilities Resident Appraisal, Preplacement Appraisal and medication list. From 1:29 p.m. to 2:02 p.m., LPA interviewed, R1 and two (02) more staff. LPA’s review of R1’s record corroborates R1 is unable to leave the facility unassisted due to R1’s diagnosis which may cause R1 to become confused and disoriented. LPA’s interview with four (04) staff present on the day in question corroborate R1 did exit the facility but deny that R1 was unsupervised. LPA's interview with S1 revealed they rushed to R1 outside and followed R1 trying to redirect them to return to the facility, then a bystander contacted 911 for assistance. According to S1, police retuned the resident to the facility. R1's, responsible party confirmed staff contacted them when the incident occurred. Resident interviews corroborate they are supervised and those that may leave the building may sign out at reception and those that need assistance go out as groups. Three (03) out of the ten (10) residents reported they had witnessed different residents attempt to leave the building or making it out of the building but according to them staff always responded and assisted the residents back into the facility. LPA Rios submitted a call of service request to the local police department but has not received a response. R1 did not recall the events that took place on 02/04/2025.

Based on interviews and observations this allegation is deemed Unsubstantiated at this time.

Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
LIC9099 (FAS) - (06/04)
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