<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603698
Report Date: 09/25/2025
Date Signed: 09/25/2025 03:53:01 PM

Document Has Been Signed on 09/25/2025 03:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 GLENDORAFACILITY NUMBER:
198603698
ADMINISTRATOR/
DIRECTOR:		OGOT, PAMELAFACILITY TYPE:
740
ADDRESS:452 SELLERS STREETTELEPHONE:
(818) 242-9000
CITY:GLENDORASTATE: CAZIP CODE:
91741
CAPACITY: 34CENSUS: 5DATE:
09/25/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:27 AM
MET WITH:Pamela Ogot, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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
Licensing Program Analysts (LPAs) Blanca Gonzalez and Nune Margaryan conducted an announced Pre-Licensing Inspection visit and met with Administrator Pamela Ogot, Chief Executive Officer Tillman Pink Jr and Quality Assurance Director Melissa Flores. This Pre-Licensing Inspection is due to a change of ownership.
The facility has an approved fire clearance to be licensed to serve twenty-four (24) non-ambulatory residents and ten (10) bedridden for a total capacity of 34 adults aged 60 and older. Bedridden rooms are #3, # 4, #7, #8, #12 and #14. The facility has a census of 5 residents. LPAs and Applicant toured the physical plant interior and exterior.

The following was observed/inspected:
The facility is in a residential neighborhood of Glendora and consists of 17 resident bedrooms, 13 bathrooms, kitchen, living room/dining room/activity room, medication room, nurse station, administrator office, conference room, lobby, reception area and garden/outdoor area. The facility temperature at the time of visit was comfortable. Required postings observed in the hallway. Auditory devices on doors leading to exterior were observed and operable. No delayed egress on exterior doors.

continued on LIC 809C
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Blanca Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 GLENDORA
FACILITY NUMBER: 198603698
VISIT DATE: 09/25/2025
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
continued from LIC 809 (page 2)

Smoke detectors and four (4) fire extinguishers were observed throughout the facility. The facility is equipped with a fire alarm and sprinkler system. A carbon monoxide detector was observed in the hallway, was tested and is operable.
A secured hallway closet contained cleaning supplies, toxins and disinfectants that were inaccessible to residents. Dining room/living room/activity room were observed clean and comfortable with sufficient seating for residents in care. Vending machines observed in dining area. LPAs observed sufficient space to accommodate both indoor and outdoor activities. Activities calendar was posted in the hallway.
Garden/outdoor area was easily accessible to residents through the dining room, protected from traffic, but did not have adequate shaded seating areas. Outdoor furniture was dirty with bird droppings and seat cushions were in disrepair. Passageways were clean and free of obstructions. No pools or large bodies of water.
Kitchen was observed clean and free of litter, rodents, vermin and insects. Refrigerator and freezers were observed clean and operating at time of visit. Currently, due to only having five (5) residents, meals are not prepared on site. Prepared meals are brought from sister facility in Monrovia. Pantry was observed to have enough non-perishable food supply for 7 days. Centrally stored medications are maintained in a secured med room inaccessible to residents. Medication room was inspected and medication was reviewed.
Locked laundry room was observed to be clean and detergent secured. Washing machine and dryer were in working order. Extra clean linens were observed in linen storage area. LPAs inspected all bedrooms (occupied and non-occupied) and observed that a few resident bedrooms did not contain the required furniture. Bed linens were clean and in good repair. There was closet space for clothing and other belongings.
Bedroom #14 is designated for bedridden and is currently used and furnished as an activity room.

continued on LIC 809 C
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Blanca Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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 GLENDORA
FACILITY NUMBER: 198603698
VISIT DATE: 09/25/2025
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
(page 3)
Resident bathrooms were observed clean. Grab bars and non-slip mats observed in all bathrooms besides the bathroom located in the hallway for residents to use for bedrooms #17 and #18. Also, the water temperature measured 129°F, which is not within the required range of 105-120°F and did not have grab bars in the shower. Resident bedrooms #17 and #18 located at the back of the facility are attached to the main building, connected by the laundry room. Rooms #17 and #18 have additional access through the Garden/outdoor area accessible through the dining room. LPAs observed that the area where Rooms #17 and #18 are located did not have smoke detectors (need clarification).

The following Corrections need to be made prior to clearing the facility for License:
• Outdoor furniture must be cleaned and seat cushions in good repair
• Adjust water temperature in bathroom for rooms #17 and #18 to measure within the required range of 105-120°F
• Add grab bars to shower in bathroom for rooms #17 and #18
• Convert room #14 from activity room back to resident bedroom, as described on facility sketch
• Licensee will ensure all 17 resident bedrooms contain required furnishing consisting of: for each resident, a chair, nightstand, a lamp, or lights sufficient for reading, a bed including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads.
Pre-licensing is incomplete with corrections to be resolved by October 6.
Facility administrator will advise LPA of corrections. A follow up inspection to verify corrections have been made will be conducted.

Exit interview conducted and a copy of this report was provided to Administrator Pamela Ogot. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Blanca Gonzalez
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/25/2025
LIC809 (FAS) - (06/04)
Page: 4 of 4