197609005-8-20-2024-31-AS-NMAN-DLRRXA-20250922132425

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 08/20/2024
Date Signed: 08/20/2024 04:23:27 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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
08/15/2024 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20240815143315

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:	08/20/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Carlos Lara, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not prevent resident from developing a pressure injury

Staff does not ensure resident receives adequate incontinence care

Staff allowed resident to sleep in a wheelchair overnight

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegations. LPA met with Administrator Carlos Lara and explained the reason for the visit.

It was reported that staff did not prevent resident from developing a pressure injury. To investigate the allegation on 8/20/2024 between 10:30am and 11:30am, staff interviews were initiated. Interviews revealed that Resident #1 (R1) does not have a pressure injury. R1 has a fungal infection on their buttocks that is being treated by home heatth care. Between 11:30am and 12pm, LPA reviewed facility records. Records confirmed what staff told LPA.

Based on interviews and records review there is not sufficient information to support this allegation. Thus, ths allegation is UNSUBSTANTIATED att this time.

Continue on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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 31-AS-20240815143315

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLEN TERRA ASSISTED LIVING	FACILITY NUMBER: 197609005
	VISIT DATE: 08/20/2024

NARRATIVE

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It was alleged that staff does not ensure resident receives adequate incontinence care. It was reported that R1 was left in a wet diaper for an extended period of time. To investigate this allegation on 08/20/2024 between 10:30am and 11:30am, staff interviews were initiated. Interviews revealed that staff change residents diapers every two hours or as often as needed. R1 is checked on more often by staff since they have a history of skin breakdown and due to their diagnosis of diaper dermatitis. Between 11:30am and 12pm, LPA reviewed facility records. Records confirmed what staff told LPA. LPA attempted to interview R1, but they were not able to answer any questions.

Based on interviews and records review there is not sufficient information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

It was reported that staff allowed resident to sleep in a wheelchair overnight. To investigate this allegation between 10:30am and 11:30am, staff interviews were initiated. Interviews revealed that night staff constantly check on residents throughout the night and do not allow residents to sleep in their wheelchairs. In addition, staff indicated that R1 has a history of making up stories in order to get attention.

Based on interviews there is not sufficient information to support the allegation. Thus, the allegation is UNSUBSTANTIATED at this time.

No health and safety issues noted at this time.

Exit interview conducted and a copy of the report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Rosaura Valenzuela
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

LIC9099 (FAS) - (06/04)

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