GLEN PARK AT LONG BEACH

Official classification

Type B

Official code

87411(a)

Regulation authority

CCR

What the official deficiency says

87411 Personnel Requirements - General (a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required... This requirement is not met as evidence by: Based on interview, Licensee failed provide necessary supervision services to meet resident needs and eloped from the facility unattended. This violation possesses a potential Health and Safety risk to residents in care.

Official plan of correction

The Licensee will adhere to the regulations and ensure review of Title 22, Section 87411. The Licensee will provide care staff training to address (NCD) wandering and elopement behaviors—proof of correction, including a sign sheet, to be sent by fax to the El Segundo Regional office at 424-544-1016 by 08/27/26.

Deadline recorded: Aug 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465)(c)(2) Incidental Medical and Dental Care. If the resident's physician has stated in writing that the resident is unable to determine his/her own need .. facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Based on the records review, staff administered (R1) Buspirone, Hydrocodone, Metformin, and Metoprolol in error. The facility reported a medication not prescribed to (R1). This violation poses/posed an immediate risk to persons in care.

Official plan of correction

Licensee shall provide medication administration retraining. This training shall be provided by pharmacy and/or registered nurse. Submit proof of training by POC due.07/09/26.

Deadline recorded: Jul 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465

Regulation authority

CCR

What the official deficiency says

87465)(c)(2) Incidental Medical and Dental Care. If the resident's physician has stated in writing that the resident is unable to determine his/her own need ........ facility staff designated by the licensee shall be permitted to assist the resident with self-administration, provided all of the following requirements are met: Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Based on the records review, facility staff did not verify the medication record and administered medication Metform that was not prescribed to (R1). The facility reported a medication error: administering the wrong medications intended for another resident with the same last name. This violation poses/posed an immediate risk to persons in care.

Official plan of correction

Licensee shall provide medication administration in-service training to all staff that dispense medications. This training shall be provided by pharmacy and/or registered nurse. Submit proof of training by POC due.06/16/26. Citation was cleared during the visit. Medication training took place on 06/10/26 with a registered nurse.

Deadline recorded: Jun 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidence by: Based on record review, the licensee did not comply with the section cited above in not submitting Unusual Incident to the department for incidents with Resident 1 on 2/20/2025, 3/20/2025, 3/11/2025, 3/22/2025, and 2/17/2025. This posed a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

The Executive Director has agreed to retrain staff on Reporting Requirements. Email trainings to Socorro.Leandro@dss.ca.gov.

Deadline recorded: Jun 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(a)

Regulation authority

CCR

What the official deficiency says

Reappraisals (a) The pre-admission appraisal, as specified in Section 87457, Pre-Admission Appraisal, shall be updated in writing as frequently as necessary or once every 12 months, whichever occurs first, to note significant changes in condition, as defined in Section 87101, Definitions, and to keep the appraisal accurate. For the purposes of this section, the updated pre-admission appraisal shall be referred to as the reappraisal. This requirement is not met as evidence by: Based on record review, the licensee did not comply with the section cited above in not having a yearly reappraisal for Resident 1 (R1). This posed a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

The Executive Director has agreed to create an updated reappraisal with R1 and email updated reappraisal to Socorro.Leandro@dss.ca.gov.

Deadline recorded: Jun 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(h)(1-3)

Regulation authority

CCR

What the official deficiency says

Reappraisals (h) The licensee shall request that all residents receive an annual routine visit with a licensed medical professional once every twelve months, either in person or by video appointment. (1) Documentation of the annual routine visit, such as a visit summary, shall be added to the resident's record. (2) Documentation of a resident's refusal to receive an annual routine visit, or if applicable, their representative's refusal on their behalf, shall be added to the resident's record. (3) If a resident refuses to receive an annual routine visit, or if applicable, their representative refuses an annual routine visit on their behalf, but later agrees to one, documentation of the annual routine visit shall be added to the resident’s record. This requirement is not met as evidence by: Based on record review, the licensee did not comply with the section cited above in not having a documented annual medical routine visit for R1. This posed a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

On 5/29/2026, the Executive Director provided LPA with an updated physician's report for R1.

Deadline recorded: Jun 16, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(f)(1)

Regulation authority

CCR

What the official deficiency says

Personnel Records: All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours. . .information is otherwise readily available in another document or format. Based on observation and record review, the facility did not provide staff training upon request in a timely manner for staff from hire date to present. This posed a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

Facility will submit all staff training records for the employees listed on the LIC811 from Complaint Control #11-AS-20251104162513. and submit the plan of correction by due date and email proof to LPA Brown at Zina.Brown@dss.ca.gov

Deadline recorded: May 13, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements(a)(1)Each licensee shall submit serious incident reports to. . . the Department may require, including the following: (1) A written report shall be submitted to the licensing agency & to the person responsible for the resident within 7 days of the occurrence of any of the events This requirement was not met as evidenced by: based observation, LPA observed that the facility did submit a LIC 624 to the department within 7 day of incident occurring.

Official plan of correction

The facility shall will submit a serious incident reports (by 01/08/2026) for the incident that occur on 12/09/2025 with the resident (R10) who had an unwitnessed fall & went to the hospital. Also the facility will conduct an in-service training on reporting requirement for all staff. The completion of training must be fax to 424-544-1016 or zina.brown@dss.ca.gov to department by POC due date.

Deadline recorded: Jan 21, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87628(b)(1-3)

Regulation authority

CCR

What the official deficiency says

Diabetes (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (1) Assisting residents with self-administered medication as specified in Section 87465, Incidental Medical and Dental Care Services. (2) Ensuring that sufficient amounts of medicines, testing equipment, syringes, needles and other supplies are maintained and stored in the facility as specified in Section 87465(c). (3) Ensuring that syringes and needles are disposed of as specified in Section 87303(f)(2). This requirement is not met as evidenced by: Based on observation, interviews and records reviewed the licensee did not comply with the section cited above in not assisting residents with self-administering medications such as insulin injections and glucose testing with a glucometer, the facility did not ensure that sufficient amounts of testing equipment such as glucometers were in the facility, and the facility has improperly disposed of needles, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

The Executive Director has agreed to read Diabetes 87628 (b)(1-3) and create a plan to stay in compliance. The Executive Director has agreed to train Medical Technicians (MedTechs) on “hand-over-hand.” The plan and trainings will be emailed to Socorro.Leandro@dss.ca.gov

Deadline recorded: Jan 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(1)(A)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (h) The following requirements shall apply to medications which are centrally stored: (1) Medications shall be centrally stored under the following circumstances: (A) The preservation of medicines requires refrigeration, if the resident has no private refrigerator. This requirement is not met as evidenced by: Based on observation and record review the licensee did not comply with the section cited above in not preserving medication as required because the medication that required refrigeration was in a refrigerator that was too hot, the refrigerator was at 55 degrees Fahrenheit and insulin medication and other medications needed to be refrigerated at 36 to 46 degrees Fahrenheit, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

On 12/12/2025, staff placed a new refrigerator in the medication room The Executive Director has agreed to create a plan to preserve medication that requires refrigeration, follows medication guidelines and at correct temperature. The Executive Director has agreed to train staff on said plan. The plan and trainings will be emailed to Socorro.Leandro@dss.ca.gov

Deadline recorded: Jan 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement is not met as evidenced by: Based on interviews and records review the licensee did not comply with the section cited above in not submitting Unusual Incident Reports to the facility regarding having Sherriffs coming out to the facility and providing R1 with a L.A. Superior Court, Long Beach, Eviction Restoration Notice dated 10/06/2025.

Official plan of correction

The Assistant Administrator has agreed to: fax Unusual Incident Reports regarding R1 to the department; re-read CCR Reporting Requirements and understand the regulation; re-train staff on how to submit Unusual Incident Reports. Email proof of correction to Socorro.Leandro@dss.ca.gov

Deadline recorded: Oct 31, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(6)(A-F)

Regulation authority

CCR

What the official deficiency says

(h) The following requirements shall apply to medications which are centrally stored: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: (A) The name of the resident for whom prescribed. (B) The name of the prescribing physician. (C) The drug name, strength and quantity. (D) The date filled. (E) The prescription number and the name of the issuing pharmacy. (F) Instructions, if any, regarding control and custody of the medication. Deficient Practice Statement Based on observation and record review, the licensee did not comply with the section cited above for LPA observed 9 out of 9 resident MARs to indicate that medication was given but no signature. LPA also observed medication not administered but had signature indicated that it was administered, this poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 08/07/2025 Plan of Correction The licensee will have all staff who assist residents in care with medication administration to be re-trained by a licensed professional pharmacist. Proof of the training conducted to be submitted to the de[artment via email zina.brown@dss.ca.gov by POC due date and also the licensee to ensure medication audits are conducted regularly to avoid discrepencies.

Official classification

Type B

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, interview and records review the licensee did not comply with the section cited above as staff #9 did not have a personnel record on file for LPA to review which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 07/31/2025 Plan of Correction The licensee will personnel records such as the LIC 501, LIC 503 with TB Test results, LIC 508, First Aid/CPR certification for Staff #9 and submit proof to the department by via email at zina.brown@dss.ca.gov by POC due date.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

Each licensee shall furnish to the licensing agency such reports as the Department may require...A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. Based on interviews conducted and records review licensee failed to report that R1 was placed on a 5150 hold which poses a health and safety risk to residents in care

Official plan of correction

Director to submit a plan to ensure facility is in compliance with 87211 (a)(1) and submit plan outlining the steps that will be taken to ensure compliance of section cited. Plan to be submitted to LPA by POC due date

Deadline recorded: May 12, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(a)

Regulation authority

CCR

What the official deficiency says

87506 (a) Resident Records The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirement was not met as evidence by: On 01/23/25 around 2:15 PM, LPA received partial records controlled medication count records for Residents #1 - 5 which poses a potential personal rights risk to residents in care. LPA did not receive medication administration records issued by the former Executive Director (S1).

Official plan of correction

The Licensee will provided controlled medication count records from April 2024 - November 2024 for Residents #1 - 5. The Licensee will also provide July 2024 - Oct 1, 2024 Medication Administration Records issued by former Executive Director (S1) by the POC due date.

Deadline recorded: Jan 28, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Based on interviews and observations, R-9’s bathroom medicine cabinet is rusted in the inside which poses a possible health and safety risk to persons in care.

Official plan of correction

The Interim Administrator, Melissa Flores shall replace medicine cabinet and send proof of correction to LPA Felisa Shirley at felisa.shirley@dss.ca.gov or fax to 424-544-1016 by POC date of 12/30/24.

Deadline recorded: Dec 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87356(a)(2)(3)

Regulation authority

CCR

What the official deficiency says

87356 Criminal Record Exemption(a)The Department shall notify a licensee to act immediately to terminate the employment of, remove from the facility or bar from entering the facility any person described in Sections 87356(a)(1) through (5) below while the Department considers granting or denying an exemption. Upon notification, the licensee shall comply with the notice. (2) Any person who has been convicted of a felony;(3) Any person who has been convicted of an offense specified in Sections 243.4, 273a, 273d, 273g, or 368 of the Penal Code or any other crime specified in Health and Safety Code Section 1569.17(c)(3); This was not met based on observation, record review, and interview, the licensee failed to ensure S1 is fingerprint cleared prior to working in the facility. This poses a health, saftey, and/or persoanl rights risk to residents in care.

Official plan of correction

Administrator shall read Section 87356(a)(1) through (5) and shall self-certify understanding of the regulations and shall commit to comply. POC shall be submitted to CCLD via email to wendy.gibbs@dss.ca.gov by the POC due date.

Deadline recorded: Nov 7, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(6)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. Deficient Practice Statement Based on observation, interview, and record review, the licensee did not comply with the section cited above as during medication reviews, LPA observed documentation on the MAR indicating if residents refused or missed taking medication throughout the week which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 10/10/2024 Plan of Correction The executive director will ensure a in-service training regard medication documentation is completed by POC due date and provide proof of in-service training for all staff via email at zina.brown@dss.ca.gov

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (a)The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in room 220 the fan in the bathroom did not have a cover over it, which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 11/02/2022 Plan of Correction Administrator will ensure the fan will be covered and in good working condition by the plan of corrections date.

Official classification

Type A

Official code

87309(a)(1)

Regulation authority

CCR

What the official deficiency says

87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.(1)Storage areas for poisons, and firearms and other dangerous weapons shall be locked. This requirement is not met as evidenced by: Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in the activity room there was a paper cutter accesibe to residents and in the garden area there was a shovel and pick axe out and storage sheds 1 and 2 were unlocked whose contents contained chemicals and gardening tools which poses an immediate health and safety risk to persons in care.

Official plan of correction

POC Due Date: 10/27/2022 Plan of Correction During the visit the Administrator put the paper cutter, shovel, pick axe in storage areas that are inaccessible to residents. The Administrator also ensured all storge spaces were locked. Cleared at the time of visit.