197609005-7-22-2022-28-AS-RORN-CJ9L64-20220914082805

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 07/19/2022
Date Signed: 07/22/2022 07:30:05 AM

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
07/15/2022 and conducted by Evaluator Luis Mora

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220715161618

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: 97	DATE:	07/19/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Carlos Lara - Administrator		TIME COMPLETED:	11:45 PM

ALLEGATION(S):

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Staff removed resident's personal belongings without permission
Facility did not communicate removal of personal belonging to responsible party

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPA met with Administrator Carlos Lara and explained the reason for the visit.

The investigation consisted of the following: LPA obtained a copy of the residents and staff rosters, conducted a tour of room number 126, and interviewed the Administrator, Resident 1 (R1), and R1's Social Worker.

The investigation revealed the following: regarding the allegation "staff removed resident's personal belongings without permission", it is alleged that the facility staff removed an electrical burner from R1's room without permission. Interviews conducted with R1 and social worker revealed that it was not the staff that removed the electrical burner. R1's power of attorney (POA) removed the electrical burner and did not notified the facility. The social worker found out it was the POA yesterday during a telephone meeting.
(CONTINUED TO LIC 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

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-20220715161618

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: 07/19/2022

NARRATIVE

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The investigation revealed the following: regarding the allegation "facility did not communicate removal of personal belonging to responsible party", it is alleged that the facility did not notify R1's responsible party of the removal of the electrical burner from R1's room. However, interview conducted with the administrator revealed that they were not aware that the electrical burner was removed from R1's room. It was found out yesterday during a telephone meeting between the administrator, R1's son, R1's social worker, R1's power of attorney that it was R1's power of attorney that took the electrical burner and did not notify the facility.

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 held and a copy of the report was provided.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Luis Mora	TELEPHONE: 323-981-3964
LICENSING EVALUATOR SIGNATURE:	DATE: 07/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/19/2022

LIC9099 (FAS) - (06/04)

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