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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 07/21/2025
Date Signed: 07/21/2025 10:02:37 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
06/25/2025 and conducted by Evaluator Angelica Segovia
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250625091857
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:
07/21/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Susan Park- AdministratorTIME COMPLETED:
10:20 AM
ALLEGATION(S):
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Staff inappropriately isolated resident.
Staff did not ensure resident was provided with a comfortable environment.
Staff did not ensure resident was provided with activities.
Staff restricted resident’s access to their personal belongings.
Staff spoke to resident in an inappropriate manner.
INVESTIGATION FINDINGS:
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On 7/21/2025 at approximately 9:30 AM, Licensing Program Analyst (LPA) Angelica Segovia conducted an unannounced subsequent complaint visit to the facility. LPA was greeted by the staff and stated the reason for their visit was to deliver the findings of the complaint. The Administrator Susan Park arrived shortly after to assist with today's visit.

To investigate the allegation(s), on 7/02/2025 at approximately 10:00 AM, LPA conducted a physical plant tour. By 11:00 AM, LPA requested relevant documentation. From 11:30 AM to 2:30 PM, LPA conducted record review and interviewed four (4) residents (R1-R4) and attempted interviews with six (6) staff members (S1-S6).


(continue to LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
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-20250625091857
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 - MARIPOSA ST
FACILITY NUMBER: 197608506
VISIT DATE: 07/21/2025
NARRATIVE
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Regarding the allegation: Staff inappropriately isolated resident. It was alleged that R1 was placed in isolation after being discharged from the hospital, although they were not deemed contagious. To investigate the allegation, LPA interviewed one (1) staff member and one (1) resident. Interview with S1 revealed that when R1 was discharged from the hospital, they were given instructions to place R1 in isolation until their symptoms had subsided. Interview with R1 revealed that they were made aware of their diagnosis while hospitalized and when they returned to the facility, they “…understood and did not object to being isolated…”. LPA’s record review confirmed the instructions given by R1’s Physician stated R1 needed to be placed in, “Isolation”. Further record review of the facility’s Infectious Control Plan (2022) showcased the facility’s policy outlining their procedures to help minimize and/or eliminate exposures related to airborne communicable diseases. Such procedures include precautionary steps involving the avoidance of small, enclosed areas where continual contact with others can or may occur. During LPA’s physical plant tour, LPA observed R1’s bedroom to be a shared room with another resident. LPA observed the temporary room R1 was placed in to be a single room separate from other residents.

Based on interviews, record review and observations, the facility followed R1’s physicians order including their Infectious Control Plan regarding R1’s isolation, therefore the allegation is UNSUBSTANTIATED at this time.

Regarding the allegation: Staff did not ensure resident was provided with a comfortable environment. It was alleged that R1 was placed in a temporary room where they could hear staff giggling, talking and the radio playing. LPA’s record review of R1’s Admission Agreement revealed that they are to be provided with such amenities as: a comfortable and suitable bed and bedroom furniture. During LPA’s physical plant tour, LPA observed the bedroom R1 was temporarily placed in. LPA observed the room to be neat, clean and organized. LPA observed the bedroom to be equipped with the following: a bed, a closet, a drawer, a chair, a small refrigerator and a bathroom. Additionally, LPA observed the immediate surroundings outside of the bedroom. LPA observed there to be a workstation assigned to the Medication Technicians (Med-Techs). However, LPA observed the station to be empty and observed the Med-techs conducting their rounds throughout the facility. LPA did not observe any radio or music being played. LPA did not observe there to be any staff near the bedroom conversating loudly.

Based on record review and observation, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

(Continue to LIC 9099-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 31-AS-20250625091857
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 - MARIPOSA ST
FACILITY NUMBER: 197608506
VISIT DATE: 07/21/2025
NARRATIVE
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Regarding the allegation: Staff did not ensure resident was provided with activities. It was alleged that R1 was not provided with a television and/or any activities for them to do. To investigate the allegation, LPA interviewed four (4) staff members and one (1) resident. Interview with all four (4) staff members confirmed that R1 was provided with their laptop and cell phone. LPA’s interview with R1 confirmed that staff did provide them with their electronic equipment, however they were not provided with a television. LPA’s interview with S1 stated that a television was not included in their services but instead considered a resident’s own personal inventory. S1 stated that they offered to bring R1’s television from their room but R1 declined. Interview with R1 confirmed that they, “…didn’t want them touching my TV because I didn’t want them breaking anything”. Further interview with S1 revealed that S5 attempted to call R1 multiple times to inquire if they needed any other activities. LPA’s interview with R1 confirmed that S5 did attempt to call them but they refused to answer. R1 did state that if they would have spoken to S5, they could have asked for anything and S5, “…would have helped me”. LPA attempted to interview S5 but they were not present during LPA’s visit nor could be reached. LPA’s record review of R1’s Personal Property Inventory confirmed a television was listed. Additionally, LPA’s record review of R1’s Admission Agreement under the Facility’s Basic Services plan confirmed that such equipment is not provided. During LPA’s physical plant tour, LPA observed R1’s television mounted onto the wall of their bedroom.

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

Regarding the allegation: Staff restricted resident’s access to their personal belongings. It was alleged that R1 was not given access to their personal belongings. To investigate the allegation, LPA interviewed four (4) staff members and one (1) resident. All four (4) staff members confirmed that R1 was given access to their personal belongings such as clothing and electronic equipment. Interview with S2 stated that when R1 would ask for, “…clothes…I would take them…”. Interview with R1 confirmed they were provided with their clothing and electronic equipment.

Based on interview with R1 that staff did allow them access to their personal belongings, the allegation is UNSUBSTANTIATED at this time.

(Continue to LIC 9099-C)

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 31-AS-20250625091857
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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 - MARIPOSA ST
FACILITY NUMBER: 197608506
VISIT DATE: 07/21/2025
NARRATIVE
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Regarding the allegation: Staff spoke to resident in an inappropriate manner. It was alleged that R1 was yelled at by a staff member. To investigate the allegation, LPA interviewed four (4) staff members and four (4) residents. Interview with R1 revealed that S1 had yelled at them during a phone conversation. Interview with S1 revealed that when they spoke with R1, R1 was upset and raised their voice. S1 stated they told R1, “…my pitch is a little high because I am trying to explain to you, but I am not yelling at you”. Additional interviews with three (3) staff members stated that they have never yelled or witnessed a staff member yell at a resident. LPA’s interview with two (2) out of the four (4) residents stated that they have never witnessed staff yell at any residents nor have they been yelled at.

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

No immediate health and safety issues observed during the day of the visit. Exit interview conducted and a copy of this report was provided to the Administrator.

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Angelica Segovia
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4