197609005-1-27-2026-31-AS-NMAN-DR92AK-20260212161340

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 01/27/2026
Date Signed: 01/27/2026 11:12:27 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
07/14/2025 and conducted by Evaluator Antonia Alvizar-Ettima

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20250714163010

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:	07:15 AM
MET WITH:	Samuel Adzhemyan,Maintenance Griselda Valdez, Housekeeper & Carlos Lara, Executive Director (ED)		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Facility staff hit client with an object, resulting in bruising

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. At about 9:00a.m. Executive Director (ED) joined us.

During initial visit on 07/16/25 at approximately 9:15a.m., LPA requests and receives copies of the facility resident and staff rosters, copies of the staff schedule, staff contact information and other pertinent documents. At 9:30a.m., ED and LPA conducted a physical plant walk-through. Between 11:30a.m. – 1:15p.m., LPA interviewed ED, four (04) out of one hundred one (101) residents and about 3:35pm., LPA interviewed two (02) staff. LPA asked questions relevant to the investigation. LPA request copies of resident #1 (R1) Physician Report, Identification & Emergency Information, and other pertinent documentation.
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-20250714163010

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

During subsequent visits on 11/04/25 between 11:30a.m. – 3:45p.m., LPA interviewed additional three (03) out of one hundred one (101) residents and on 01/06/26 LPA interviewed three (03) additional residents via -phone. Prior to this visit on 12/20/25 LPA Alvizar-Ettima reviewed records and other documentation obtained during the initial visit.

Facility staff hit client with an object, resulting in bruising

It was alleged that during nighttime hours, a staff member became upset because Resident #1 (R1) was out of bed. R1 reported that staff folded R1's walker and began swinging toward R1. R1 states they blocked the walker with the back of their hand, resulting in bruising to the back of both hands.

During interviews with R1 revealed inconsistent statements regarding the incident. R1 appeared confused and was unable to clearly describe the events. R1 later stated they may have hurt themselves but could not provide specific details. Staff #1 (S1) and Staff #2 (S2) denied hitting R1. Both staff reported R1 was confused, attempting to leave the facility at night, throwing personal belongings, yelling, and exhibiting agitated behavior. Staff reported attempts to redirect R1 back to bed. S2 reported hearing R1 state, “Oh, I hurt myself,” but did not witness an injury occur. The Executive Director reported R1 has a history of nighttime confusion and behavioral episodes and denied staff misconduct. During interviews with residents, ten (10) out of one hundred one (101) residents reveal staff has not hit them and did not observed staff hitting R1. Resident #2 (R2) reported R1 is outspoken and has a history of agitation but R2 did not witness the incident. During facility visits, LPA observed staff present in resident areas, engaged in resident care activities, and responsive to resident needs. No inappropriate staff conduct was observed. Facility records indicated R1 has mild cognitive impairment and is not permitted to leave the facility unassisted.

Based on interviews, observation and review records, there is insufficient information to support the allegation. Therefore, 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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