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Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609005
Report Date:
04/12/2022
Date Signed:
04/12/2022 01:32:59 PM
Substantiated
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/25/2020
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20200325144834
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:
92
DATE:
04/12/2022
UNANNOUNCED
TIME BEGAN:
10:30 AM
MET WITH:
Carlos Lara
TIME COMPLETED:
12:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not preventing the spread of an outbreak.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent complaint visit to finish investigation into the allegation above. LPA met with the administrator and explained the reason for this visit. LPA conducted a physical plant tour to ensure no immediate health and safety issues from 10:45-11:15pm. No immediate health and safety issues were noted. LPA observed staff to be wearing mask throughout the facility and hand sanitizers were available throughout the facility.
LPA conducted the intial visit on 4/1/2020 where interview was done with the administrator. It is alleged that facility staff failed to wear mask consistently around the facility and were not ensuring that residents were social distancing from one another. Since this complaint came in facility had an annual visit on 8/3/21 and a case management visit on 10/5/21. During both visits it was noted that staff were not wearing mask properly and that residents were not observed to be social distancing by the LPA's who conducted those visits. Deficiencies were cited on both visits and since then deficiencies have been cleared. Due to those visits happening after this complaint came in this allegation is deemed Substantiated however no deficiency will be cited due to the facility already correcting the deficiencies issued on visits on 8/3/21 and 10/5/21.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Jill Nakata
TELEPHONE:
(818) 596-4377
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/12/2022
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
2
Control Number
31-AS-20200325144834
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
21731 VENTURA BLVD., STE. 250
WOODLAND HILLS
,
CA
91364
FACILITY NAME:
GLEN TERRA ASSISTED LIVING
FACILITY NUMBER:
197609005
VISIT DATE:
04/12/2022
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
Exit Interview conducted.
SUPERVISOR'S NAME:
Jill Nakata
TELEPHONE:
(818) 596-4377
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
04/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/12/2022
LIC9099
(FAS) - (06/04)
Page:
2
of
2