198602134-1-15-2025-11-AS-UCOL-DEBUUZ-20250228145423

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 01/15/2025
Date Signed: 01/15/2025 03:17:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/13/2025 and conducted by Evaluator Socorro Leandro

COMPLAINT CONTROL NUMBER: 11-AS-20250113085224

FACILITY NAME:	GLEN PARK AT LONG BEACH		FACILITY NUMBER:	198602134
ADMINISTRATOR:	MICHAEL MENDOZA		FACILITY TYPE:	740
ADDRESS:	1046 E 4TH ST		TELEPHONE:	(562) 432-7468
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90802
CAPACITY:	208	CENSUS: 90	DATE:	01/15/2025
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Quality Assurance Director - Melissa Flores		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff are not ensuring residents have clean linens
Staff are not assisting residents with changing clothes
Staff are not assisting residents with showers
Staff are not assisting residents with medications timely
Staff do not assist resident with follow-up medical appointments

INVESTIGATION FINDINGS:

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On 1/15/2025, the Department of Social Services (DSS) - Community Care Licensing Division (CCLD) staff conducted an unannounced complaint visit at this facility. CCLD staff was greeted by Quality Assurance Director, Melissa Flores.

The investigation consisted of the following:
The department interviewed 5 staff, 11 residents, and attempted to interview 2 residents; toured the laundry room, medication room, and 7 resident rooms; reviewed staff roster, resident roster, shower schedule, and Medication Administration Records (MARs).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025

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 11-AS-20250113085224

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT LONG BEACH	FACILITY NUMBER: 198602134
	VISIT DATE: 01/15/2025

NARRATIVE

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The investigation revealed the following:

Regarding the allegation “staff are not ensuring residents have clean linens”, it is being alleged that residents’ linens are soiled. Interviews conducted revealed the following: 11 out of 11 residents denied the allegation and 5 out of 5 staff denied the allegation. Observations revealed the following: the department toured 7 resident rooms and did not observe soiled linens. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

Regarding the allegation “Staff are not assisting residents with changing clothes”, it is being alleged that staff are not assisting residents in changing clothes (e.g. soiled clothing). Interviews conducted revealed the following: 11 out of 11 residents denied the allegation and 5 out of 5 staff denied the allegation. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

Regarding the allegation “Staff are not assisting residents with showers”, it is being alleged that staff are not assisting residents with showers. Interviews conducted revealed the following: 11 out of 11 residents denied the allegation and 5 out of 5 staff denied the allegation. Records reviewed revealed the following: the facility has a Shower Schedule which describes residents who require assistance, reminders, stand by, independent, etc. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

Regarding the allegation “Staff are not assisting residents with medications timely”, it is being alleged that staff are not providing residents with their medication in a timely manner. Interviews conducted revealed the following: 10 out of 11 residents denied the allegation and 5 out of 5 staff denied the allegation. Records reviewed revealed the following: 5 out of 5 Medication Administration Records (MARs) indicate that medications were provided to residents during the prescribed time frame. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250113085224

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT LONG BEACH	FACILITY NUMBER: 198602134
	VISIT DATE: 01/15/2025

NARRATIVE

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Regarding the allegation “Staff do not assist resident with follow-up medical appointments”, it is being alleged that staff refuse to assist residents with follow-up medical appointments. Interviews conducted revealed the following: 10 out of 11 residents denied the allegation and 5 out of 5 staff denied the allegation. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

No citations were issued.

An exit interview was conducted, and a copy of this report was left with the Quality Assurance Director.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2025

LIC9099 (FAS) - (06/04)

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