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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603698
Report Date: 09/28/2026
Date Signed: 09/28/2026 01:28:06 PM

Document Has Been Signed on 09/28/2026 01:28 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:		PAUL KRAUSEFACILITY TYPE:
740
ADDRESS:452 SELLERS STREETTELEPHONE:
(818) 242-9000
CITY:GLENDORASTATE: CAZIP CODE:
91741
CAPACITY: 34CENSUS: 9DATE:
09/28/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:10 AM
MET WITH:Edgar Littaua, Office Manager TIME VISIT/
INSPECTION COMPLETED:
01:35 PM
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Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual inspection using the Compliance and Regulatory Enforcement (CARE) Tool. LPA was greeted by facility staff and informed them of the purpose of the visit. LPA was provided a tour of the facility and assisted by Edgar Littaua, Office Manager. Administrator Stacie Anderson was contacted via telephone.

The facility’s fire clearance is approved for thirty-four (34) non-ambulatory residents, ages 60 and over, of whom ten (10) may be bedridden in Rooms 3, 4, 7, 8, 12, and 14. The facility also maintains a hospice waiver for ten (10) residents. At the time of the inspection, no residents were receiving hospice care.

Facility Tour & Observations:

Required postings, including Personal Rights (LIC 613C), Long-Term Care Ombudsman information, Complaint Poster (PUB 475), and the nondiscrimination notice, were observed posted in a common area and accessible to residents and visitors. Residents were observed to have access to personal space, privacy, and adequate storage for personal belongings. No firearms or other weapons were present at the facility.

Physical Plant

Facility Tour & Physical Plant:

The facility is located in a residential area and consists of a single-story building divided into three (3) wings. Upon entering the facility, LPA observed the front lobby/reception area, conference room, and Administrator’s office.

The South Wing consists of a nurses’ station, medication room, public restroom, staff break room, and four (4) resident bedrooms. Room #7 was observed to be undergoing renovations at the time of the inspection.

The North Wing consists of six (6) resident bedrooms and a public restroom. During the inspection, LPA observed that the window screens in Room #14 needed replacement.

David Sicairos
Gabriela Castro
DATE: 09/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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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)
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Document Has Been Signed on 09/28/2026 01:28 PM - It Cannot Be Edited


Created By: Gabriela Castro On 09/28/2026 at 12:59 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN PARK AT GLENDORA
FACILITY NUMBER: 198603698

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
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
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During the facility walkthrough, LPA observed that the window screens in Room #14 were in need of replacement. LPA also observed that several resident rooms were undergoing renovations. Additionally, the facility’s boiler equipment was observed to be leaking water and in need of repair. These conditions pose a potential health and safety risk to residents in care.
POC Due Date: 10/23/2026
Plan of Correction
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The facility will replace the damaged window screens in Room #14 and ensure that all window screens are maintained in good repair. The facility will complete the necessary repairs to the boiler equipment to address the observed water leak and ensure the equipment is maintained in safe operating condition. Resident rooms currently undergoing renovations will be completed. The Administrator will submit documentation of the completed corrections, including photographs and/or repair invoices or service records, to Licensing by the POC due date.
Type B
Section Cited
CCR
87608(a)(5)(A)
Postural Supports
(A) A bed rail that extends from the head half the length of the bed and used only for assistance with mobility shall be allowed.

This requirement is not met as evidenced by:
Deficient Practice Statement
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During the facility walkthrough, LPA observed bed rails in use in Residents R2 and R4’s bedrooms. During record review, LPA did not observe physician’s orders authorizing the use of bed rails for R2 and R4. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/23/2026
Plan of Correction
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The facility will review the records of all residents currently utilizing half bed rails to ensure that the required physician’s orders authorizing the use of the half bed rails are current and maintained in each resident’s file. The facility will obtain any missing physician’s orders, as applicable. Documentation demonstrating that the facility completed the record review and copies of the required physician’s orders will be submitted to Licensing by the POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
David Sicairos
NAME OF LICENSING PROGRAM MANAGER:
Gabriela Castro
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/28/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2026


LIC809 (FAS) - (06/04)
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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: 09/28/2026
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The West Wing consists of the activity room/dining area, kitchen, storage room for cleaning supplies, laundry room, and five (5) resident bedrooms. LPA observed a sufficient supply of food, including emergency food supplies. Office Manager Edgar Littau reported that the facility receives food deliveries for breakfast, lunch, and dinner from their other location in Monrovia. Room #3 was reported to be undergoing upgrades at the time of the inspection. An office utilized by the Activity Coordinator is located behind the laundry room. LPA also observed an additional bedroom that was not in use and another room utilized for storage. The facility’s boiler equipment is located near the laundry room area. During the inspection, LPA observed water leaking directly from the boiler equipment. Resident bedrooms observed contained required furnishings, including beds, mattresses, linens, dressers, chairs, and adequate lighting. Bathrooms inspected were observed to be clean and maintained in sanitary condition. Bathrooms were equipped with required safety features, including grab bars near toilets and bathing areas and non-skid surfaces/mats to reduce the risk of falls. Toilets, sinks, and bathing fixtures were observed to be operational. Hot water was available for resident use. Cleaning supplies, toxic substances, and other potentially hazardous items were stored in designated areas and inaccessible to residents. Extra linens and towels were available for resident use. Smoke and carbon monoxide detectors were observed, and fire extinguishers were available throughout the facility. Passageways, hallways, and exits were observed to be clear and unobstructed. No bodies of water were observed on the premises.
The outdoor patio area was observed to be well maintained and provided ample shaded seating areas for residents’ use.

Food Service

Refrigerators and freezers were maintained at proper temperatures (refrigerators at a maximum of 40°F and freezers at 0°F) and contained a sufficient supply of food, including at least two (2) days of perishable food and seven (7) days of non-perishable food. Fresh produce, proteins, and dry goods were stocked.

Health-Related Services & Records

Four (4) resident files were reviewed. Files contained current required documentation including Admission Agreements, signed consents, Needs and Service Plans, Physician’s Reports documenting TB results and ambulatory status, and Resident Rights acknowledgments.

Four (4) residents’ medications were reviewed. Medications were observed to be centrally stored in a locked in med room and med carts.

(continued on 809C)

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Gabriela Castro
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2026
LIC809 (FAS) - (06/04)
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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: 09/28/2026
NARRATIVE
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Disaster Preparedness:

The most recent fire/earthquake drill was conducted on August 28, 2026, with staff and resident participation. The facility’s fire alarm and fire sprinkler systems were last inspected/serviced by Earl Security, Inc. on September 2, 2026. The LIC 610D Emergency Disaster Plan was available for review and was in the process of being updated at the time of the inspection. Emergency supplies, including water, food, flashlights, batteries, and first aid supplies, were observed and available for use in the event of an emergency.

Personnel Records & Training

Four (4) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Stacie Anderson was valid through October 15, 2027.

An exit interview was conducted with Edgar Littaua, Office Manager. During the inspection, deficiencies were observed and cited on the attached LIC 809D/809C in accordance with Title 22, Division 6 regulations. A copy of this report, LIC 809D/809C, and appeal rights will be provided.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Gabriela Castro
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/28/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2026
LIC809 (FAS) - (06/04)
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