197609005-9-22-2021-28-AS-FFIS-C768WX-20210923225330

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609005
Report Date: 09/22/2021
Date Signed: 09/22/2021 01:16:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/27/2019 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20191127133704

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: 88	DATE:	09/22/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator Carlos Lara		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility is not providing comfortable living accommodations to resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation regarding the above allegation. LPA Villalobos met Administrator Carlos Lara and explained the reason for the visit.

The investigation consisted of the following: LPA Villalobos requested staff/resident roster, interviewed staff #1-#5 (S1-S5), and residents #1-#6 (R1-R6), LPA toured the facility and observed rooms #111, # 222, #325 and #402.

The investigation revealed the following: In regards to the allegation, "Facility is not providing comfortable living accommodations to resident " it was alleged that residents with wheelchairs could not access the bathrooms sinks. (5) of (5) staff interviewed denied the allegation. (6) of (6) residents interviewed could not corroborate the allegation. LPA observed that each resident room has a private bathroom...

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

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 28-AS-20191127133704

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: GLEN TERRA ASSISTED LIVING	FACILITY NUMBER: 197609005
	VISIT DATE: 09/22/2021

NARRATIVE

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The resident bathrooms in the facility are all identical with low height bathroom sinks. LPA observed R1 and R2 using their wheelchair and accessing the bathroom sink on their own. Interviews show facility staff will provide assistance to residents if needed and when residents ask for help. Based on LPA's observations, interviews and documents reviewed the preponderance of evidence standard has not been met, therefore the above allegation is UNSUBSTANTIATED.

Exit interview was conducted with Administrator Carlos Lara and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2021

LIC9099 (FAS) - (06/04)

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