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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602134
Report Date: 11/19/2025
Date Signed: 11/19/2025 04:33:17 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/04/2025 and conducted by Evaluator Zina Brown
COMPLAINT CONTROL NUMBER: 11-AS-20251104162513
FACILITY NAME:GLEN PARK AT LONG BEACHFACILITY NUMBER:
198602134
ADMINISTRATOR:MICHAEL MENDOZAFACILITY TYPE:
740
ADDRESS:1046 E 4TH STTELEPHONE:
(562) 432-7468
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY:208CENSUS: 105DATE:
11/19/2025
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Jennifer Rivas, Executive DirectorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff mismanaged resident medication
INVESTIGATION FINDINGS:
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On 11/19/2025, at 8:45am, Licensing Program Analyst (LPA) Zina Brown conducted a subsequent visit at this facility to deliver the complaint finding for the allegation above. During today’s visit, LPA met with Jennifer Rivas (Executive Director) and the purpose of the visit was explained.

The investigation consisted of the following:
On 11/13/2025, LPA conducted interviews with Administrator (A1), Staff (S1-S10) & Residents (R1 - R10) between the hours of 8:29am - 2:30pm. LPA also requested and received the following documents: Staff Roster (dated 11/07/2025), Resident Roster (dated 11/01/2025), Resident #1's personnel record such as LIC 503 Pre-Placement Appraisal (dated 09/28/2022), LIC 602: Physician Report (dated 07/27/2023), Admission Agreement (dated 08/01/2024) & Dietary Preference (dated 10/25/2022), Fall Menu Week 3 (October & November 2025) and Medication Administration Record for R1 - R10 (for October - November 2025).

Report continues on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
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 5
Control Number 11-AS-20251104162513
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
VISIT DATE: 11/19/2025
NARRATIVE
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The investigation revealed the following:
Allegation: Staff mismanaged resident medication
It was alleged that for the last 3 months a resident medications have been passed out late.

On 11/13/2025 between the hours of 11:12am - 11:22am, LPA interviewed A1 who denied the allegation and stated the facility uses a medication cart for medtech to administer the medication to the residents. A1 also stated the facility just suspended two (2) medtech for lack of performance and Technical Support Program (TSP) provided by the Department of Social Service Community Care Licensing came to the facility about two weeks ago to assist with medication training.

On 11/13/2025, between 9:15am - 1:21 pm, LPA interviewed 9 staff:
2 of 9 staff confirmed the allegation and stated due to short staff  and or stopping to help assist another resident there have been challenges with timely medication administration
2 of 9 staff denied the allegation and stated not rushing to administrator medication quickly to avoid making a mistake while another staff stated it's no there hasn't been any challenges with timely medication administration
5 of 9 staff were unaware and or have no knowledge of the allegation due to their assigned job roles such a receptionist, caregiver, and activities director.

On 11/13/2025, between 8:29am- 2:00pm, LPA interviewed 10 residents:
4 of 10 residents confirmed and stated by R1 that medication were for 3 months while other residents such as R3, R7 and R9 stated their medication being given late or missed once before.
3 of 10 residents denied and stated never experienced receiving their medication being given late nor missed.
3 of 10 residents did not confirm nor deny the allegation due to R6 stating no comment while R8 stated not remembering and R10 have not having any knowledge of their medication being give late or missed.

On 11/19/2025, between the hours of 9am - 11am, LPA conducted medication review for 10 residents (R1 - R10) and observed the following: Medication Administration Record (MAR) for November 2025 indicated the medtechs administered medication by initial & timestamp. However medication is still observed to be in the bubble for
Resident 1 (R1) 8pm Pregabalin 150mg on 11/1, 11/04, 11/1/11 and 11/18
Resident 1 (R1) 6:30am Pantoprazole SD DR 40 on 11/01
Resident 5 (R5) 8pm Rosuvastatin Calcium 10 MG  on 11/09
Resident 5 (R5) 6:30am Pantoprazole SD DR 40 MG  on 11/01
Resident 9 (R9) 8pm Atorvastatin 40 MG on 11/13, 11/14 and 11/15

Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED under California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D and a copy of this report was provided with appeal rights.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20251104162513
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/17/2025
Section Cited
CCR
87465(a)(4)
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Incidental Medical & Dental Care (a) A plan for incidental medical care shall be developed by each facility. The plan shall encourage routine medical care & assist in obtaining care, by compliance with..: (4) the licensee shall assist residents with self-administered medication as needed
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The Administrator will have a licensed Pharmacist provide additional medication training for all the medtech and the LVN will conduct daily audits for Medication Administration for the next 30 days.
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This requirement was not met as evidenced by interviews, observations, and record review showing medications for R1, R5, and R9 were not administered as prescribed. However, LPA observed medications not given but signed out, posing a health and safety risk to residents.
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The facility will submit the proof of correction to the CCLD/El Segundo ASC Office via fax at 424-544-1016 Attn: Zina Brown or via email at zina.brown@dss.ca.gov by the POC due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/04/2025 and conducted by Evaluator Zina Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20251104162513

FACILITY NAME:GLEN PARK AT LONG BEACHFACILITY NUMBER:
198602134
ADMINISTRATOR:MICHAEL MENDOZAFACILITY TYPE:
740
ADDRESS:1046 E 4TH STTELEPHONE:
(562) 432-7468
CITY:LONG BEACHSTATE: CAZIP CODE:
90802
CAPACITY:208CENSUS: 105DATE:
11/19/2025
UNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Jennifer Rivas, Executive DirectorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility does not have a certified Administrator.
INVESTIGATION FINDINGS:
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On 11/19/2025, at 8:45am, Licensing Program Analyst (LPA) Zina Brown conducted a subsequent visit at this facility to deliver the complaint finding for the allegation above. During today’s visit, LPA met with Jennifer Rivas (Executive Director) and the purpose of the visit was explained.

The investigation consisted of the following:
On 11/13/2025, LPA conducted interviews with Administrator (A1), Staff (S1-S10) & Residents (R1 - R10) between the hours of 8:29am - 2:30pm. LPA also requested and received the following documents: Staff Roster (dated 11/07/2025), Resident Roster (dated 11/01/2025), Resident #1's personnel record such as LIC 503 Pre-Placement Appraisal (dated 09/28/2022), LIC 602: Physician Report (dated 07/27/2023), Admission Agreement (dated 08/01/2024) & Dietary Preference (dated 10/25/2022), Fall Menu Week 3 (October & November 2025).

Report continues on LIC 9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20251104162513
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: GLEN PARK AT LONG BEACH
FACILITY NUMBER: 198602134
VISIT DATE: 11/19/2025
NARRATIVE
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The investigation revealed the following:

Allegation: Facility does not have a certified Administrator
It was alleged that the facility does not have a certified Administrator since Michael Mendoza.
On 11/13/2025 between the hours of 11:12am - 11:22am, LPA interviewed A1 who stated Melissa Flores is currently acting as the facility Administrator and is not sure how long she's been in the position. A1 stated she has a Administrator certification.

On 11/13/2025, between 9:15am - 1:21 pm, LPA interviewed 9 staff: 9 of 9 staff denied the allegation and stated Jennifer Rivas has been acting as the facility Administrator for a couple months.

On 11/13/2025, between 8:29am- 2:00pm, LPA interviewed 10 residents:
1 of 10 resident denied the allegation and stated Jennifer Rivas is the current Administrator of the facility
9 of 10 are unaware of the allegation.

On 11/17/2025, between the hours of  2:20pm - 2:30pm, LPA conducted a records review and observed the following: The previous Administrator for the facility was Michael Mendoza. Upon the departure of Michael Mendoza, the facility had Melissa Flores acting as the Administrator who held a Administrator Certification effective 08/11/2023 - 08/11/2025. On 11/7/2025 LPA received an email from Jennifer Rivas who provided her Proof of Completion for Certification Program for 740 - Residential Care Facility for the Elderly effective as of 02/23/2024 - 02/23/2026.

Unfounded: This agency has investigated the complaint alleging (for the allegation above). We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

Exit interview conducted with Jennifer Rivas (Administrator) and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5