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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 02/20/2024
Date Signed: 02/20/2024 04:59:45 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
02/12/2024 and conducted by Evaluator Rosaura Valenzuela
COMPLAINT CONTROL NUMBER: 31-AS-20240212090733
FACILITY NAME:GLEN TERRA ASSISTED LIVINGFACILITY NUMBER:
197609005
ADMINISTRATOR:RECORDS, TERRYFACILITY TYPE:
740
ADDRESS:917 N LOUISE STREETTELEPHONE:
(818) 291-1918
CITY:GLENDALESTATE: CAZIP CODE:
91207
CAPACITY:155CENSUS: 91DATE:
02/20/2024
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Carlos Lara, AdministratorTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Staff are not providing basic care to resident
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegation. LPA met with Administrator Carlos Lara and explained the reason for the visit.

It was reported that staff are not providing basic care to resident. To investigate this allegation on 02/20/2024 between 1:10pm and 2:00pm, staff interviews were initiated. Interviews revealed that Resident #1 (R1) is being well taken care of and is also receiving Hospice services. From 2/05-2/10, R1 had been experiencing diarrhea. Both the facility and their responsible party were aware of the situation. Facility informed responsible party that R1 probably required antibiotics to treat the diarrhea. R1's responsible party did not want them to take antibiotics. Moreover, responsible party wanted R1 to take a natural remedy. Facility told responsible that the facility could not administrator any medication without a medical order. R1's responsible party became upset with facility staff, but then agreed to R1 taking antibiotics. Between 2:00pm and 2:45pm, LPA reviewed facility records. Records confirmed that R1 is receiving Hospice services and that R1 was treated for diarrhea and is now stable. Between 3:50pm and 4:00pm, LPA saw R1 in the front lobby.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024
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 2
Control Number 31-AS-20240212090733
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: 02/20/2024
NARRATIVE
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LPA observed R1 to be clean, well nourished, and in good spirits.

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

No health and safety issues noted at the time of this visit.

Exit interview conducted and a copy of the report was issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2