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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850221
Report Date: 03/30/2023
Date Signed: 03/30/2023 04:26:34 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/15/2023 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20230315122126
FACILITY NAME:GLEN PARK AT OJAIFACILITY NUMBER:
565850221
ADMINISTRATOR:GARY Y LEEFACILITY TYPE:
740
ADDRESS:225 N LOMITA AVETELEPHONE:
(805) 646-2402
CITY:OJAISTATE: CAZIP CODE:
93023
CAPACITY:48CENSUS: 15DATE:
03/30/2023
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Gary LeeTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Staff are abusing the residents while in care
Staff are yelling at the residents
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Esther Cortez & Kelly Dulek conducted unannounced subsequent complaint visit at 8:40 a.m. to the above facility. Tri-Counties Regional Center (TCRC) Quality Assurance Specialist (QAS) Liz Aced-Arnett was also present during today’s visit. LPAs met with Executive Director (ED) Gary Lee and the reason for the visit was explained.

On 03/23/2023, during the initial 10-day visit, LPAs Cortez and Chochian toured the facility from 9:50 a.m. - 10:40 a.m. along with the ED. LPAs also conducted interviews with six (6) facility residents between 10:45 a.m.-12:15 p.m. and six (6) facility staff between 2:45 p.m.- 5:30 p.m. Moreover, during the visit, LPAs conducted a file review and obtained pertinent documentation between 1:15 p.m. – 2:40 p.m. Additional documentation was requested and obtained from ED on 03/27/2023 and 03/29/2023. On 03/29/2023 at 1:58 p.m., LPA Cortez conducted an interview with Staff #1 (S1). During today’s subsequent visit, LPAs Cortez and Dulek along with TCRC QAS and facility ED toured the facility between 11:03 a.m. – 11:30 a.m.
Report continued on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
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 29-AS-20230315122126
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT OJAI
FACILITY NUMBER: 565850221
VISIT DATE: 03/30/2023
NARRATIVE
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Additional interviews were done with three (3) staff between 11:34 a.m.- 12:25 p.m. File review began at 12:30 p.m. and one (1) resident interview at 1:16 p.m.

It was alleged that staff are abusing the residents while in care. The Reporting Party (RP) did not provide any further details regarding the allegation. During the course of the investigation, documents obtained, and interviews conducted revealed that there were concerns regarding S1 rough handling residents in care. Documents obtained and reviewed reflected that S1 was provided two (2) coaching (write up) by Gary Lee for four (4) separate incidents reported by either staff or residents. Based on information gathered, S1 was witnessed yelling at two (2) residents, throwing the dining room phone on the floor, and not allowing residents to leave the dining room. On a second incident, it was reported that S1 grabbed a resident by the nose where the resident had a hard time breathing. On a third incident, it was reported that S1 has been very rough with a resident when changing incontinence diapers, and “throws resident around”. Lastly, records reflected that S1 sprayed body soap in a residents’ eyes. During the interview with S1, S1 admitted to spraying residents with incontinence spray on their bodies and hair. S1 further stated that S1 accidentally sprays residents in the eyes if they do not close their eyes when instructed to by S1. Additionally, S1 also admitted that while S1 was playing around with a resident, S1 grabbed residents’ nose too hard stating “I guess I grabbed his nose too hard”. S1 admitted having been abusive towards the residents based on S1’s actions. S1 further explained that S1 has become angry at work due to the environment, being overworked and stressed out. Based on information obtained, the Department has sufficient evidence to determine that S1 abused residents in care; therefore, the above allegation “staff are abusing residents while in care” is deemed SUBSTANTIATED at this time.

It was also alleged that staff are yelling at the residents. RP did not provide any further details regarding the allegation. However, interviews revealed that S1 has had at least three (3) incidents involving S1 yelling when other staff had to intervene between residents and S1. Based on information gathered during the course of the investigation, it was determined that staff have witnessed S1 raise their voice and yell at residents. It was further revealed that staff have reported to administration when staff witnessed residents being yelled at. S1 received two (2) write up/coaching for four (4) separate incidents, one of which included yelling at residents. During interview with S1, S1 acknowledged that S1 did yell at the residents and received a coaching/write up. S1 further admitted to yelling at more than one resident and raising S1’s voice on multiple occasions. Based on information gathered, the Department has sufficient evidence to determine that staff yell at residents. Therefore, the above allegation is deemed SUBSTANTIATED at this time.

Report will continue on LIC 9099C


SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 29-AS-20230315122126
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: GLEN PARK AT OJAI
FACILITY NUMBER: 565850221
VISIT DATE: 03/30/2023
NARRATIVE
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The following deficiencies were observed (See LIC 9099-D) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. ED Gary Lee was informed that failure to correct the deficiencies may result in civil penalties.

Exit interview conducted with ED Gary Lee. A copy of the report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20230315122126
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN PARK AT OJAI
FACILITY NUMBER: 565850221
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/30/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/30/2023
Section Cited
CCR
87468.1(a)(3)
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87468.1Personal Rights of Residents in All Facilities (a)(3)To be free from punishment, humiliation, intimidation, abuse, or other actions...interfering with daily living functions such as eating, sleeping, or elimination.This requirement is not met as evidence by:
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Executive Director provided documentation of coachings for S1. Administrator has suspended S1 today and S1 has been asked to leave the builduing pending a dicision from human resources.Administrator
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Based on Interviews, Records obtained and S1 admission. The licensee did not comply with the above cited section as S1 admitting to abusive actions towards residents including incontinence spray, and grabbing residents nose, which poses an immidiate personal rights risk to residents in care.
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Admisistrator will conduct all staff training of personal rights and mandated reporting and provide proof and submit documentation of attendees to CCL by 04/06/2023.
Type A
03/30/2023
Section Cited
CCR
87468.1(a)(1)
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87468.1Personal Rights of Residents in All Facilities (a)(1)To be accorded dignity in their personal relationships with staff, residents, and other persons. This requirement is not met as evidence by:
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Executive Director provided documentation of coachings for S1. Administrator has suspended S1 today and S1 has been asked to leave the builduing pending a dicision from human resources.Administrator
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Based on Interviews, Records obtained and S1 admission. The licensee did not comply with the above cited section as S1 admitted to yelling at residents, multiple staff witnessed S1 yell at residents. Which poses an immidiate personal rights risk to residents in care.
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Admisistrator will conduct all staff training of personal rights and mandated reporting and provide proof and submit documentation of attendees to CCL by 04/06/2023.
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: Desaree Perera
LICENSING EVALUATOR NAME: Esther Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5