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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609005
Report Date: 08/31/2023
Date Signed: 08/31/2023 04:48:06 PM


Document Has Been Signed on 08/31/2023 04:48 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LIVINGFACILITY NUMBER:
197609005
ADMINISTRATOR:RECORDS, TERRYFACILITY TYPE:
740
ADDRESS:917 N LOUISE STREETTELEPHONE:
(818) 291-1918
CITY:GLENDALESTATE: CAZIP CODE:
91207
CAPACITY:155CENSUS: DATE:
08/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Carlos Lara, AdministratorTIME COMPLETED:
04:50 PM
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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced inspection visit. LPA met with Administrator Carlos Lara. The purpose of the visit was explained.

Facility is licensed to served 155 non - ambulatory residents, of which 4 may be bedridden and has a hospice waiver for 20 residents. Facility is a 4 story building, with a lobby, dining room, 2 activity rooms, a kitchen, a small outdoor shaded patio, medication room is on the second floor, and a salon in the third floor. Fire alarm sprinkle system was observed throughout the facility. There are no large bodies of water in the property.

LPA Valenzuela conducted a walk through with and observed the following:


Facility is clean and free of odors in common areas. Elevators are in working condition.

All bedrooms have the proper bedding, and furniture.

The facility maintains a comfortable temperature at 78 degrees. The smoke detectors are hardwired and interconnected and observed to be operational. There are carbon monoxide detectors in the facility. Fire extinguishers are located throughout the facility and were last serviced in May of 2023.



The bathrooms were checked for cleanliness and proper operation. LPAs observed the appropriate grab bars in the showers and toilets. The hot water temperature was measured at 111.5 degrees.

LPA observed seven days worth of perishable and non-perishable food.

Exit interview conducted. A copy of this report was issued and signature obtained.
No deficiencies were issued at this time
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:
DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/31/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 08/31/2023
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SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura ValenzuelaTELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023
LIC809 (FAS) - (06/04)
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