197609005-12-30-2021-28-AS-MVAO-CC6SJ5-20220303125433

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 12/30/2021
Date Signed: 12/30/2021 03:13:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/23/2021 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211223152217

FACILITY NAME:	GLEN TERRA ASSISTED LIVING		FACILITY NUMBER:	197609005
ADMINISTRATOR:	RECORDS, TERRY		FACILITY TYPE:	740
ADDRESS:	917 N LOUISE STREET		TELEPHONE:	(818) 291-1918
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91207
CAPACITY:	155	CENSUS: 90	DATE:	12/30/2021
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Carlos Lara		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Residents are being subjected to second-hand smoke.
Facility has pest infestation.
Facility is not notifying residents of bedbugs.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint visit in response to the above allegations. LPA met with Administrator, Carlos Lara, Director of Community relations, Tony Rios who assisted with today's visit.

Regarding the allegation that residents are being subjected to second -hand smoke, the investigation consisted of interviews with Licensee, Administrator, Director of community relations and resident #1 - resident #8. Staff interviewed stated that they have been notified by some residents that resident #1 has smoked in his room. Staff stated that smoking is not allowed in the facility. Staff interviewed said that there is a designated smoking area on the patio, and they have reminded resident #1 that smoking in resident rooms is not permitted. Resident #1 denied that he smokes in his room. He stated that he is aware of the house rules, and complies with them. 8 out of 8 residents interviewed, stated that they are not being subjected to second hand smoke. They stated that they are not aware that any residents are smoking in their room.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20211223152217

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN TERRA ASSISTED LIVING	FACILITY NUMBER: 197609005
	VISIT DATE: 12/30/2021

NARRATIVE

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Regarding the allegation that the facility has a pest infestation and the allegation that the facility is not notifying residents of bedbugs, the investigation consisted of interviews with Licensee, Administrator, Director of community relations and resident #1 - resident #8. Staff interviewed denied that the facility has a pest infestation of any kind. Staff also denied that the facility has bed bugs. Staff interviewed, stated that they have a contract with a pest control company, and they service the facility weekly. Staff provided copies of recent pest control invoices for several months. Based on review of pest service invoices, there is no indication that the facility has bed bugs. 8 out of 8 residents stated that they have not observed that the facility has a pest infestation. 8 out of 8 residents stated that the facility does not have a bed bug problem at this time.

Based on LPA's observations and interviews, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Administrator, Carlos Lara.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 12/30/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2021

LIC9099 (FAS) - (06/04)

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