197609005-1-27-2026-31-AS-NMAN-DVXRMP-20260713130904

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 01/27/2026
Date Signed: 01/27/2026 11:47:55 AM

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
10/29/2025 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20251029102336

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:	01/27/2026
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Samuel Adzhemyan,Maintenance Griselda Valdez, Housekeeper & Carlos Lara, Executive Director (ED)		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Staff do not prevent resident from physically assaulting another resident

INVESTIGATION FINDINGS:

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At 7:15a.m., Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced subsequent visit to deliver finding of the above noted allegation. LPA met with Housekeeper, Maintenance and granted entry to the facility. LPA explained the reason for this visit. At 7:35a.m., LPA and Maintenance conducted a physical plan tour and observed no health no safety issues.

It was alleged that on or around 10/28/2025, resident #1 (R1) was physically assaulted by Resident#2 (R2) and staff only spoke with R2 and did not further address the matter. To investigate the allegation, during initial visit on 11/04/25 at approximately 10:15a.m., LPA requests and receives copies of the facility resident and staff rosters, copies of R1 & R2 Physician Report, Identification Emergency Information, Appraisal/Needs & Services Plan and other pertinent documentation. Between 11:30a.m. – 3:45p.m., LPA interviewed ED, DCR and four (04) out of one hundred one (101) residents including R1, R2 and other residents that have knowledge of the incident. Involving R1 and R2.
Cont. on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2026

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-20251029102336

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: 01/27/2026

NARRATIVE

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Cont. from LIC 9099-C

ED and other staff revealed that they had knowledge of the incident. However, there was no physical altercation between R1 and R2. According to staff, even though R2 has health condition that reflect their physical and mental condition, R2 is not combative towards others. R2 likes to walk around and at times walks to close to other residents. On 10/25/25, R2 walked towards R1 and asked for candy. R1 refused and R2 threw water on R1. Staff immediately intervened and redirected R2. Police was called by R1 and no report was filed, due to absence of verifiable information.

During interviews with R1 revealed inconsistent statements regarding the incident. R1 was unable to clearly describe the events. LPA attempted to speak with R2 and she was unable to respond to LPAs questions.

A review of residents’ records and incident reports verified the information revealed from staff.

Overall investigation revealed that although there was an incident involving R1 and R2, there is no sufficient information and/or evidence to verify that there was physical altercation between residents. Therefore, based on interviews and record review, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazard noted during this visit.

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

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2026

LIC9099 (FAS) - (06/04)

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