197609005-3-18-2026-31-AS-NMAN-DVYP9F-20260714110704

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 03/18/2026
Date Signed: 03/18/2026 10:47:50 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
10/30/2025 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20251030144748

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: 99	DATE:	03/18/2026
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Executive Director (ED), Carlos Lara		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Facility staff did not prevent a resident from threatening another resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced subsequent visit to deliver finding of the above noted allegation. LPA met with ED and explained the reason for this visit. During this visit at approximately 10:00a.m., LPA and ED conducted a physical plan tour and observed no health and safety issues.

It was alleged that on 10/30/25, the resident #1 (R1) was threatened by another facility resident #2 (R2) to "beat them up" and wanted to "go outside" to fight. R2 also used "explicative language". About a month ago, there was a disagreement in the dining room over seating involving R1 and R2.

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
Cont. on LIC 9099 -C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:	DATE: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

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-20251030144748

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: 03/18/2026

NARRATIVE

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Cont. from LIC 9099

11:30a.m. – 3:45p.m., LPA interviewed ED, other staff and four (04) out of one hundred one (101) residents including R1, R2 and other residents that have knowledge of the incident.

ED and other staff revealed that staff did not witness any incident of verb altercation between R1 and R2. R2 came and reported to staff that while R2 and three (3) other residents were sitting outside having a conversation, R1 walked towards them and accused R2 of talking about R1. R2 denied the accusation and told R1 to leave them alone and continue talking with R3. R1 walked away. Staff never received any complaints from R1 regarding the incident. R1 did not want to talk to staff about it.
During interviews R1 revealed inconsistent statements regarding the incident. R2 and other residents present during incident verified the information received from staff.

A review of residents’ records and other internal documents did not reveal any pertinent information to verify the allegation.

Overall investigation revealed that although there was an incident involving R1 and R2, there is no sufficient information and/or evidence to verify that R2 threatened R1. 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: 03/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2026

LIC9099 (FAS) - (06/04)

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