197609005-4-20-2023-31-AS-MVAO-CR8U4G-20230425151508

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 04/20/2023
Date Signed: 04/20/2023 02:54:35 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, 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
04/18/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20230418170420

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:	04/20/2023
		UNANNOUNCED	TIME BEGAN:	11:05 AM
MET WITH:	Anahit Tupinyan		TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belongings
Staff financially abused resident

INVESTIGATION FINDINGS:

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At 11:05 am. on 04/20/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the Administrator and disclosed the reason for the visit. LPA and S2 toured the facility at 2:30 p.m. No immediate health or safety concerns were observed.

Regarding the allegation “Staff did not safeguard resident's personal belongings”, it was alleged Staff #1 (S1) took the purse of Resident #1 (R1). LPA interviewed staff, R1, and R1’s friend between 1:00 p.m. and 2:45 p.m. and reviewed records between 2:00 p.m. and 2:45 p.m. on 04/20/2023. Information obtained through interviews and record review revealed S1 was not a facility staff. S1 was a private caregiver hired by R1. R1 and R1’s friend confirmed that R1 found their purse this morning and the allegation was untrue. Based on interviews and record review, the allegation is deemed UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

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-20230418170420

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: 04/20/2023

NARRATIVE

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Regarding the allegation “Staff financially abused resident”, it was alleged S1 asked R1 for a loan, and R1 had unapproved withdrawals in their account. Record review revealed R1 was hospitalized on 04/13/2022 with a high fever and UTI which resulted in confusion. From interviews, the Administrator, S2, R1’s private caregiver, and R1’s friend confirmed that the withdrawals were payments made to R1’s private caregivers. R1’s friend confirmed R1 was confused at the hospital and made some unclear statements while there. Based on interviews and record review, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 04/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2023

LIC9099 (FAS) - (06/04)

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