197609005-7-12-2024-31-AS-TAGD-DABNLS-20241023103403

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 07/12/2024
Date Signed: 07/12/2024 02:57:32 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: 93	DATE:	07/12/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Carlos Lara - Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff are not meeting residents diapering needs

Staff are not responding to residents call buttons in a timely manner

INVESTIGATION FINDINGS:

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

LPA conducted physical plant tour at 9:30 AM, requested copies of facility documents relevant to the investigation at 10:33 AM, reviewed documents from 10:45 AM to 11:40 AM and interviewed staff and residents between 12:00 PM to 2:00 PM. Regarding the allegations that staff are not meeting residents diapering needs, it was alleged that Resident #1 (R1) has been left in soiled diapers for about 1-2 hours. LPA's interview with R1 today at 1:20 PM revealed that revealed that staff are changing R1's diaper regularly and on time for at least 3-4 times a day including nights and denied being soiled for one (1) to two (2) hours. Further interview also revealed that staff are checking on R1 regularly. LPA's interview with six (6) incontinent residents today between 12:00 PM to 2:00 PM revealed that staff changed their diaper regularly 3-4 times a day. (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: 07/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024

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-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: 07/12/2024

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that Staff are not responding to residents’ call buttons in a timely manner, it was alleged that R1 waited for 45 minutes to an hour before someone respond to R1's call. LPA's interview with R1 today revealed that whenever R1 pushed own call button, staff respond within ten (10) minutes at most. LPA's interview with three (3) residents on 03/27/24 at 12:00 PM to 1:30 PM and eight (8) residents today between 12:00 PM to 2:00 with a total of eleven (11) total residents interviewed, six (6) of which are incontinent, revealed that ten (10) out of eleven (11) residents stated that staff respond to call button within reasonable time or within three (3) minutes to a maximum of fifteen (15) minutes. One (1) out of eleven (11) resident interviewed did not use the call button while living at the facility.

Based on the information gathered during this and prior visit, these allegations are 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: 07/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2024

LIC9099 (FAS) - (06/04)

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