197609005-4-21-2022-28-AS-SCOL-CFTV6D-20220628160918

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 04/21/2022
Date Signed: 04/21/2022 03:39:03 PM

Unsubstantiated

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
04/14/2022 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220414141042

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: 94	DATE:	04/21/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Carlos Lara		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff failed to meet resident's medical needs.
Staff are not allowing visitors.
Staff failed to provide resident with a comfortable environment.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial complaint investigation visit for the above allegations. LPA Irra met with Carlos Lara (Facility Administrator) and Tony Rios (Director of Communication Relations) and discussed the purpose of today’s visit.

During this investigation, LPA interviewed Staff #1 through Staff #5. LPA also interviewed Resident #1 (R-1) and reviewed R-1’s file and obtained relevant documentation. LPA was unable to interview Resident #2 (R-2) as R-2 is non-verbal.

Refer to LIC 9099C for the continuation of this report.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

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-20220414141042

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: 04/21/2022

NARRATIVE

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Allegation: Staff failed to meet resident's medical needs. During this investigation, LPA interviewed Staff #1 through Staff #5. LPA also interviewed Resident #1 (R-1) and reviewed R-1’s file and obtained relevant documentation. (3) out of (5) staff interviews revealed that R-1 manages their own medication. (3) out of (5) interviewed Staff indicated they have a copy of R-1’s physician orders for medication including R-1’s oxygen order (concentrator and portable). Per (3) out of (5) staff interviews, R-1’s oxygen (portable) is delivered weekly by a medical supply company. Interviewed Staff indicated they do not “force” Residents to take any medication. R-1 indicated R-1 manages their own medication as well. Staff and Resident interview do not corroborate this allegation.

Allegation: Staff are not allowing visitors. During this investigation, LPA interviewed Staff #1 through Staff #5. LPA also interviewed Resident #1 (R-1). (4) out of the (5) staff interviews revealed that on 04/13/2022 R-1 received a visit from a family friend which took place outside (patio) for approximately 2 to 3 hours. Staff interviews revealed that R-1’s visitor became upset when asked to provide status of COVID-19 vaccination and/or negative COVID-19 test results. Per staff interviews, R-1’s visitor was very upset in which the facility was unable to offer a COVID-19 antigen test. S-2 indicated S-2 spoke to R-1’s family friend the following day and COVID 19 antigen testing was discussed. Per S-2, R-1’s family friend did not come in for testing and has not visited R-1 since 04/13/2022. R-1 indicated the family friend visited R-1 on 04/13/2022 and the visit was outside (patio) for approximately 3 hours. Visitation was not denied as the visit took place in the patio area of this facility. Interviews do not corroborate this allegation.

Refer to LIC 9099C for the continuation of this report.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220414141042

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: 04/21/2022

NARRATIVE

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Allegation: Staff failed to provide resident with a comfortable environment. During this investigation, LPA interviewed Staff #1 through Staff #5. LPA also interviewed Resident #1 (R-1). Room relocation: (4) out of the (5) staff interviews revealed that R-1 was offered different rooms for relocation as R-1 indicated R-1’s roommate sleeps during the day time, is awake all night and disturbs R-1. R-1 also indicated staff offered R-1 different rooms, however, R-1 did not like the rooms being offered. Laundry services: (5) out of (5) interviewed staff indicated residents’ clothes are washed separately from other residents. Interviewed staff indicated each resident has their own hamper. LPA was provided with a staff lesson plan/training that was conducted with Staff which specifically covers personal laundry procedures and states “laundry will be washed separately”. Interviewed staff indicated R-1’s roommate is not left wearing soiled/dirty diapers all night and that staff conduct rounds every (2) hours. However, staff do not keep a log of the rounds that are being conducted. Interviewed staff indicated they have not observed nor received any complaints in regards to resident being left soiled. LPA toured R-1’s bedroom and did not smell any strong odors. Per, interviews and per observation, this allegation cannot be corroborated.

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.

Exit interview was conducted, a copy of this report and Appeal Rights were provided to Carlos Lara.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 04/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/21/2022

LIC9099 (FAS) - (06/04)

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