197609005-3-14-2023-28-AS-TVAO-CQES63-20230330133514

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 03/14/2023
Date Signed: 03/14/2023 04:10:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
09/04/2020 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200904141947

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: 98	DATE:	03/14/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Carlos Lara - Administrator		TIME COMPLETED:	04:10 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

1. Facility did not meet the resident's dietary needs.
2. Facility food is of poor quality.
3. Facility did not provide a variety of foods.
4. Facility did not seek medical attention in a timely manner.
5. Facility staff are not adequately trained.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit regarding the allegations listed above. LPA met with Administrator, Carlos Lara, and explained the purpose of the visit.

The investigation consisted of the following:
On 9/11/2020, LPA J. Katrdzhyan conducted the initial visit and requested for documents pertaining to Resident #1. On 3/14/23, LPA Chan did a follow up visit to interview the Administrator, 6 Staff, 9 Residents, and a Nutrition Consultant.

The investigation revealed the following:
Allegation - Facility did not meet the resident's dietary needs. It was alleged that Resident #1 (R-1) required a heart healthy diet which was ordered by the physician. According to the Administrator and kitchen staff, the cardiac or heart healthy diet means that the sodium should be limited to the resident.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

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 3

Control Number 28-AS-20200904141947

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN TERRA ASSISTED LIVING	FACILITY NUMBER: 197609005
	VISIT DATE: 03/14/2023

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

Per the cook, the meals are prepared with low to no salt for all the residents. The nutrition consultant hired by the company is a self-contractor who comes once a month to the facility. The consultant stated that the recipes for the meals are provided to the facility and are considered nutritious with a balanced diet. LPA toured the kitchen area and observed residents with dietary needs posted on the inside bulletin board. The resident picture and their diet ordered are marked on the diet card. Staff interviewed stated they obtain information about a resident’s diet from the Med Tech and follow the orders. In regards to R-1, staff stated R-1 ate majority of the meals at the facility and sometimes the family member brought food. Some of the staff knew of the “cardiac diet” and since the meals were prepared with low sodium, R-1 did not require anything different. Based on information gathered, there is insufficient evidence to prove this allegation.

Allegation – Facility food is of poor quality. LPA toured the kitchen and observed fresh fruits and vegetables. The chef was preparing the meals and keeping the items in a warmer or covered. There were sufficient supplies of 2-day perishable and a week of non-perishable items in storage. Staff interviewed stated they used items of good quality to make the meals. They are using the fresh items and replenishing them at least once or twice a week. The nutrition consultant stated that the recipes utilizes approximately 80% of fresh ingredients and about 20% of canned goods. LPA interviewed 9 residents today. 8 out of the 9 feel that the facility uses good quality of items to cook their meals.

Allegation - Facility did not provide a variety of foods. During the visit today, LPA obtained copies of the menu for the month. The menu is posted by the dining room and LPA observed a variety of foods for the week. Per the kitchen supervisor, the menu is different each week and residents have alternative meals if they do not want the main course for lunch or dinner. The alternative choices, such as sandwiches, cheese omelet, or grilled hamburger, are posted on the dining room tables. Per staff interviewed, if a resident wants something from the alternative list, they would prepare the food at the time of request. LPA interviewed 9 residents today. 2 out of the 9 do not like the food choices and feel that there is no variety of food selections. The other 7 residents stated the facility offers variety of foods.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20200904141947

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN TERRA ASSISTED LIVING	FACILITY NUMBER: 197609005
	VISIT DATE: 03/14/2023

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

Allegation - Facility did not seek medical attention in a timely manner. It was alleged that Resident #1 (R-1) had a heart attack on 8/12/20 and asked the caregiver to call 911, but caregiver said resident was ok. LPA interviewed staff who were working on the day of incident. Staff stated that R-1 was on the video call with the family member who witnessed R-1 needing medical attention. The family member immediately contacted the facility and staff called 911 right away. The paramedics came to the facility and determined resident had a cardiac arrest with a DNR order. Administrator and Staff stated they did not observed R-1 to be in any distress prior to cardiac arrest and also stated that R-1 would have informed staff if not feeling well. The residents interviewed have not had to seek immediate medical attention but feel that the staff will intervene right away if residents need it.

Allegation - Facility staff are not adequately trained. It was alleged that the facility did not have a full-time food service manager who accounts for the resident’s dietary needs. LPA obtained the personnel report and observed a kitchen manager who works 40 hours a week. The kitchen staff receive training from the manager and the Nutrition Consultant. The Nutrition Consultant stated that training are provided to the kitchen staff and to go over any updates as needed on a monthly basis. LPA interviewed 9 residents and they feel that the kitchen staff are adequately trained to prepare food.

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.

An exit interview was conducted with the facility nurse, Anna Tupinyan. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3