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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197802560
Report Date: 12/11/2025
Date Signed: 12/11/2025 02:05:06 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/10/2025 and conducted by Evaluator Daniel Konishi
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251110150841
FACILITY NAME:GLEN PARK AT MONROVIAFACILITY NUMBER:
197802560
ADMINISTRATOR:ACHARYA, NIRJARAFACILITY TYPE:
740
ADDRESS:110 N MOUNTAIN AVETELEPHONE:
(626) 357-6818
CITY:MONROVIASTATE: CAZIP CODE:
91016
CAPACITY:49CENSUS: 47DATE:
12/11/2025
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Martha Rosas, Assistant AdministratorTIME COMPLETED:
02:10 PM
ALLEGATION(S):
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Staff caused an injury to a resident in care.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Daniel Konishi conducted a subsequent unannounced complaint visit in response to the above-mentioned allegations. LPA met with Martha Rosas, Assistant Administrator and explained the reason for the visit. Executive Director, Pamela Ogot arrived shortly after and the LPA explained the purpose of the visit.

On 11/13/2025, the initial investigation visit was conducted. The investigation consisted of the following:

LPA requested a copy of staff and resident rosters. LPA conducted a tour of facility and common areas with the Assistant Administrator. LPA also requested copies from Resident#1 (R1’s) file such as the Face Sheet, Physician’s Report, Admissions Agreement, and other pertinent documents. Assistant Administrator will send remaining pertinent documents by COB. LPA observed the residents to identify any signs of neglect, abuse, or other immediate health and safety threats. LPA did not observe any immediate health and/or safety concerns.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
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 28-AS-20251110150841
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: GLEN PARK AT MONROVIA
FACILITY NUMBER: 197802560
VISIT DATE: 12/11/2025
NARRATIVE
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During today's visit, LPA obtained the following documents: staff and resident rosters, R1’s Physician’s Orders and Hospital Discharge Notes. LPA interviewed the Executive Director, Assisted Administrator, Staff #1 (S1) to Staff #4 (S4), Resident #2 (R2) to Resident #6 (R6). LPA obtained Staff In-Service documents.

The investigation revealed the following: in regard to the allegation, "Staff caused an injury to a resident in care." It is alleged that on 01/08/2025, R1 fell and sustained a purplish bruise on R1’s face. It is also alleged that on 03/23/2025, R1 suffered another fall and was hospitalized. LPA interviewed five (5) out of five (5) residents that denied the allegation stating that they were not injured caused by staff and did not witness any residents injured caused by staff. Four (4) out of five (5) residents also stated that they feel safe. One (1) out of five (5) residents stated feeling safe but the staff are not friendly. Four (4) out of five (5) residents stated that the staff treat them good and are well cared for. LPA interviewed Executive Director, Assistant Administrator, and four (4) out of four (4) staff that denied the allegation and stated that staff have not caused any injury to residents and have not witnessed any staff injure any residents. Executive Director, Assistant Administrator, and four (4) out of four (4) staff also stated that staff follow protocol of care for a resident by on-duty staff reporting the fall immediately to the facility LVN to assess the resident’s range of motion and contact 911 and non-emergency paramedic for the resident to be transferred to the ER. Executive Director and Assistant Administrator stated that when R1 fell on 01/08/2025 and 03/23/2025, the staff responded immediately by the staff assessing R1 and since it was an unwitnessed fall, staff contacted the paramedics and R1 was sent to the ER for further evaluation. LPA reviewed Staff In-Service training on resident fall protocols dated 08/01/2025, Personal Rights dated 05/27/2025, Meeting the Resident’s Personal Needs dated 04/29/2025, and Elder Abuse Training dated 01/06/2025. There is not enough evidence to substantiate.

Based on statements and interviews conducted with staff, residents, review of client files and facility file records, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was held, and a copy of this report was provided to the Executive Director, Pamela Ogot.
SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Daniel Konishi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2025
LIC9099 (FAS) - (06/04)
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