198603413-4-29-2026-31-AS-GSAO-DTLUX2-20260429155733

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603413
Report Date: 04/28/2026
Date Signed: 04/29/2026 03:58:21 PM

Document Has Been Signed on 04/29/2026 03:58 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:	SAGE GLENDALE SENIOR LIVING		FACILITY NUMBER:	198603413
ADMINISTRATOR/ DIRECTOR:	SMITH,ANGELA		FACILITY TYPE:	740
ADDRESS:	525 W ELK AVE		TELEPHONE:	(818) 245-6378
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91204
CAPACITY: 113		CENSUS: 75	DATE:	04/28/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:25 AM
MET WITH:	Lindsay Schroeder, Executive Director		TIME VISIT/ INSPECTION COMPLETED:	02:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 04/28/26 at 8:25AM, Licensing Program Analyst (LPA) Gina Saucedo, arrived to conduct an unannounced, annual inspection at the facility. Upon arrival, LPA met with Receptionist, Esther Rodas and LPA disclosed the purpose of the visit Lindsay Schroeder, Executive Director arrived shortly after. LPAs asked for the census, resident, and staff files. A physical tour was conducted at 8:50AM and observed the following: The maximum capacity of the facility is 113 non-ambulatory residents. Nine (9) of these residents can be bedridden. Hospice Waiver is for seven (7) only. The facility is a five (5) story building. The first, third, fourth and fifth buildings are for assisted living and second floor is for memory care only. The first floor consists of the following: a lobby/living room area with a large television, administrative offices, mailboxes, dining area next to the kitchen area, activities room with a television, theater room with a television, game area, bistro area with snacks and enclosed outdoor patios with furniture and shaded areas. The third floor has a gym. The memory care which is the second floor has delayed egress doors, it's own medication room, laundry and detergents locked and inaccessible to the residents, the dining area and activity area are together withe a large television and it has an enclosed patio area. There are two (2) elevators. There are several stairways. The only stairway that had evacuation chairs was the fifth floor. LIC 809C-continued

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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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: SAGE GLENDALE SENIOR LIVING	FACILITY NUMBER: 198603413
	VISIT DATE: 04/28/2026

NARRATIVE

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Random Bedrooms were randomly selected to tour and were observed to have furniture, lighting, bedding, and televisions. Random Bathrooms were observed to have grab bars and non-skid mats. Hot water temperature was tested randomly and measured 113.5–114.1 degree Fahrenheit. The rooms have sage detectors used as call buttons that alert the staff when something is wrong.

Fire extinguishers were observed throughout the facility and were fully charged dated 04/2025 and July 2025. There are fire extinguishers upstairs, downstairs and in the kitchen area. Fire sprinklers and fire alarms are located throughout the facility and are operable.

Facility has two (2) designated medication room that is inaccessible to residents where all the medication is stored and locked in the memory care side of the facility. One is in the memory care area-second floor and the other one (1) is on the fourth floor. The medication system is called Extended Care Professional.

Common Areas: These include the dining areas, activities room, television rooms: All common areas were observed to be clean and properly furnished. Facility maintains a comfortable temperature of 70-73-degree Fahrenheit. There are several temperature thermostats throughout the facility including resident rooms.

There are several common bathrooms throughout the upstairs and downstairs area. The staff and resident bathrooms are not shared. There are trash cans with lids and covid signs posted in the common bathrooms. Sufficient supplies of toilet paper and napkins observed. The facility has no body of water. There is under ground parking that is clean, free of hazards and free from obstructions.

The Kitchen: area was toured, and LPA observed sufficient supply of non-perishable foods and perishable food for all residents. The kitchen area was clean at the time of the tour. The kitchen is located on the first floor. The assisted dining area has access to this kitchen, where at the time of the tour, different residents were observed having breakfast with proper feeding utensils/plates/cups. Next to the kitchen/dining room area is also a private area for residents to choose to eat alone. Against the wall of the kitchen on your is a Resident's Diet/Allergic Board and in the office area.

LIC 809C-continued

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

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: SAGE GLENDALE SENIOR LIVING	FACILITY NUMBER: 198603413
	VISIT DATE: 04/28/2026

NARRATIVE

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There are three (3) facility vehicles for resident use.

Resident records/Staff records: LPA conducted a complete file review of seven (07) resident files. Staff records: LPA conducted a complete file review of six (6) staff records. There are no residents that have safeguarded cash resources at the facility.

Administrative: The Insurance plan is dated as of 01/21/2027. There is an Emergency Disaster plan at the entrance of the facility towards the street, Personal Right sign, Rights of Resident Council, Licensee, Administrator Certificate and Ombudsman sign are behind the front desk on your right-side of the entrance of the facility. The liability insurance expires on 10/01/26. The last fire drill was in April 09, 2026.

Deficiencies/Citations: There are several stairways. The only stairway that had evacuation chairs was the fifth floor. There are six (6) evacuation chairs total that are needed for each floor and each stairway.

An exit interview was conducted, citation(s) were issued, appeals rights and a copy of this report was given to the Lindsay Schroeder, Executive Director.

NAME OF LICENSING PROGRAM MANAGER: Troy Agard
NAME OF LICENSING PROGRAM ANALYST: Gina Saucedo
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 04/29/2026 03:58 PM - It Cannot Be Edited

Created By: Gina Saucedo On 04/28/2026 at 12:08 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: SAGE GLENDALE SENIOR LIVING	FACILITY NUMBER: 198603413
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/28/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

HSC

1569.695(f)(1)

This requirement is not met as evidenced by:HSC 1569.695(f)(1) where as of July 2019, an evacuation chair is needed for emergency purposes.
	Deficient Practice Statement
1 2 3 4	Based on observation the licensee did not comply with the section cited above in that there is six (6) evacuation charis needed for each stairway and floor which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 05/29/2026
	Plan of Correction
1 2 3 4	The Licensee/Administrator shall make that every floor/stairway has an evacuation chair.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Troy Agard
NAME OF LICENSING PROGRAM MANAGER:

	Gina Saucedo
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

LIC809 (FAS) - (06/04)

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