197609005-3-27-2024-31-AS-TAGD-DABNLT-20241023103403

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 03/27/2024
Date Signed: 03/27/2024 02:34:52 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.ASC, 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
03/19/2024 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20240319091602

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: 92	DATE:	03/27/2024
		UNANNOUNCED	TIME BEGAN:	08:53 AM
MET WITH:	Carlos Lara - Executive Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not ensure the facility was free from pests

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit to this facility to investigate the above allegation. LPA met with Executive Director Carlos Lara and explained the reason for the visit.

LPA conducted a physical plant tour at 9:12 AM, requested copies of facility documents relevant to the investigation at 10:01 AM, reviewed records between 10:30 AM to 12:00 PM and interviewed residents between 12:00 PM to 1:30 PM. Regarding the allegation that the staff did not ensure was free from pests, it was alleged that Reporting party (RP) heard staff complaining that there are roaches in the kitchen and that RP saw roaches in the kitchen cabinet and bathrooms. During this visit, LPA toured the kitchen, random residents' room and common bathroom at 9:12 AM and did not observe any roach or pests on any of the areas visited. LPA's interview with four (4) kitchen staff today between 12:00 PM to 1:30 PM also revealed that all four (4) of them did not see any roach or any pests inside the kitchen and that they always clean the kitchen at every end of the shift. (continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

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 3

Control Number 31-AS-20240319091602

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: GLEN TERRA ASSISTED LIVING	FACILITY NUMBER: 197609005
	VISIT DATE: 03/27/2024

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

(continued from LIC 90990

Further, LPA’s interview with the Kitchen supervisor and the Executive director today between 12:00 PM to 1:30 PM also revealed that kitchen is being fumigated/treated by their contracted pest control once a month or more during summer to avoid any infestation in the kitchen. LPA's record review confirmed that the facility has a contracted pest control company that visits the facility once a month to treat/fumigate reported rooms, common areas and random rooms to avoid any kind of infestation. LPA's interview with nine (9) residents or 10% of the current census between 12:00 PM to 1:30 PM revealed that nine (9) out of nine (9) residents did not see any roaches in their room or any common areas of the facility.

Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3