197608506-8-26-2025-31-AS-MGFS-DSFQK4-20260323121343

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608506
Report Date: 08/26/2025
Date Signed: 08/26/2025 01:46:21 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
08/19/2025 and conducted by Evaluator Michael Cava

COMPLAINT CONTROL NUMBER: 31-AS-20250819150511

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: 91	DATE:	08/26/2025
		UNANNOUNCED	TIME BEGAN:	10:09 AM
MET WITH:	Jessica Favela		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not ensure resident had access to medication in a timely manner.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Michael Cava conducted a complaint visit to the faciity to investigate the above allegation. LPA met with assistant administrator Jessica Favela, and advised her of the complaint. It's being reported that Resident 1's (R1) medication for colitis, was delivered on or around 07/17/25, but R1 was not notified. When R1 called the pharmacy for a refill, the pharmacy advised R1 that the medication was delivered already, and another refill would not be available. Today's investigation consisted of a interviews with staff and residents. LPA also conducted a physical plant inspection and record review.

Interviews with the assistant administrator and three (3) out of three staff deny the allegation. Staff acknowledged that R1's medication was delivered to the facility on 07/17/25. Medication was given to the med techs for central storage, as R1 was hospitalized from 07/11/25 to 07/19/25. S1 stated R1 never missed a dose of this medication. When R1 returned from the hospital on or around 07/19/25, staff notified R1 that the medication is held in the med room and ready for R1 to keep. Medication was then given to R1,

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025

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 2

Control Number 31-AS-20250819150511

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: 08/26/2025

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

as R1 is able to manage, store, and administer their own medication.

Interviews made with ten (10) of ten residents reveal no concern or complaints of residents not having access to their medications in a timely manner. Review of R1's records reveal that R1 is able to manage and administer own medication. LPA reviewed random resident medications and Medication Administrator Records (MAR) and did not observe any discrepancy in medication records.

Based on the information obtained, there wasn't enough evidence to corroborate with the allegation of Staff not ensuring resident had access to their medication in a timely manner, Therefore the allegation is deemed Unsubstantiated at this time.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 08/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/26/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2