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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603413
Report Date: 02/13/2023
Date Signed: 02/13/2023 04:24:50 PM

Unsubstantiated


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
05/26/2022 and conducted by Evaluator Jose Villalobos
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220526134147
FACILITY NAME:SAGE GLENDALE SENIOR LIVINGFACILITY NUMBER:
198603413
ADMINISTRATOR:BERARD, MARTHAFACILITY TYPE:
740
ADDRESS:525 W ELK AVETELEPHONE:
(626) 253-2929
CITY:GLENDALESTATE: CAZIP CODE:
91204
CAPACITY:113CENSUS: 53DATE:
02/13/2023
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator Angela Monette-SmithTIME COMPLETED:
01:35 PM
ALLEGATION(S):
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Resident(s) emergency buttons are not working.
Resident sustained unwitnessed falls while in care.
Resident was left unattended for an extensive period of time while in care.
Resident is not being fed a sufficient amount of food while in care.
Facility motion dectectors are not working.
Not enough staff to meet residents needs.
Staff told Resident to use their diaper instead of assisting them to the bathroom.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jose Villalobos conducted a complaint visit to investigate the allegations listed above. LPA met with Administrator Angela Monette-Smith and explained the reason for the visit.

Initial visit was conducted on 6/1/22 and consisted of the following: LPA toured the physical plant of the facility, which included rooms #222, #218 , #312, and #524. LPA observed the food supply. LPA interviewed staff #1-#2 (S1-S2) and Resident #2 (R2). LPA was not able to interview Resident #1 (R1) as they no longer reside in the facility. LPA collected and reviewed documents from R1's resident file as well as facility staff roster and client roster.

On todays visit, LPA interviewed Staff #3-#6 (S3-S6) and Residents #3-#6 (R3-R6). LPA toured the memory care floor and room #214. R1 was unavailable for interview. The investigation revealed the following:

Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 28-AS-20220526134147
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: SAGE GLENDALE SENIOR LIVING
FACILITY NUMBER: 198603413
VISIT DATE: 02/13/2023
NARRATIVE
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In regards to the allegation "Resident(s) emergency buttons are not working." it was alleged that the emergency buttons in R1 room were not working. (6) of (6) staff interviewed denied the allegation. (5) of (5) Residents interviewed could not corroborate the allegation. LPA observed room #222 and pressed the emergency buttons during the initial visit. LPA observed staff arrive to check on the room and turn off the signal in sufficient time. LPA also tested the emergency button in room # 218 and observed the same response. Interviews with staff did not state that the emergency buttons were not working at any time. Based on the interviews conducted and observations, the investigation revealed; although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED

In regards to the allegation "Resident sustained unwitnessed falls while in care. " it was alleged that R1 was alone and had two unwitnessed falls in the facility. (6) of (6) staff interviewed denied the allegation. (5) of (5) Residents interviewed could not corroborate the allegation. LPA was not provided with dates of when the falls occurred. LPA reviewed facility files and R1's file and did not observe incident reports of R1 sustaining falls in the facility. Interviews with staff did not show R1 had unwitnessed falls in the facility. Based on the interviews conducted and records review, the investigation revealed; although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED

In regards to the allegation "Resident was left unattended for an extensive period of time while in care." it was alleged that R1 had to wait for extensive periods of time to receive help from the staff. (6) of (6) staff interviewed denied the allegation. (5) of (5) Residents interviews could not corroborate the allegation. Interviews state that staff perform routine check ins to resident rooms when they are not out in community rooms. Interviews do not state that staff will ignore residents in need of help. LPA observed, both on 6/1/22 and 2/13/23, that staff periodically walk into resident rooms to check in on residents. Based on the interviews conducted and observations, the investigation revealed; although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED

In regards to the allegation "Resident is not being fed a sufficient amount of food while in care." it was alleged that on 5/22/22 R1 was not being provided a sufficient amount food and was hungry...

Continued on LIC 9099-C
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 28-AS-20220526134147
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: SAGE GLENDALE SENIOR LIVING
FACILITY NUMBER: 198603413
VISIT DATE: 02/13/2023
NARRATIVE
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(6) of (6) staff interviewed denied the allegation. (5) of (5) Residents interviews could not corroborate the allegation. Interviews stated that the facility provides breakfast, lunch, and dinner to residents every day. The facility will also provide seconds to residents when they request it and even provide snacks. Interviews do not show that staff was aware of R1 not being given a sufficient amount of food on 5/22/22. Based on the interviews conducted and observations, the investigation revealed; although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED

In regards to the allegation "Facility motion detectors are not working." it was alleged that the motion detectors in resident rooms are not functioning. (6) of (6) staff interviewed denied the allegation. (5) of (5) Residents interviews could not corroborate the allegation. Interviews with staff stated that the motion detectors located in resident rooms send signals to the beepers that staff carry. The motion detectors are used as a way to monitor a residents location throughout the day but are not the same as an emergency signal. LPA observed the motion detector in room #222 and #218 to operational on the initial visit. Based on the interviews conducted and observations, the investigation revealed; although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED

In regards to the allegation "Not enough staff to meet residents needs" it was alleged that there is not enough staff present in the memory care unit to meet all the residents needs. (6) of (6) staff interviewed denied the allegation. (5) of (5) Residents interviews could not corroborate the allegation. Residents interviewed did not state that there are staffing issues in the facility. During the initial visit on 6/1/22, interviews with staff show that the facility keeps 3 caregivers and 1 med tech staff on each shift for the memory care unit alone. At that time there were 17 residents in the memory care unit. LPA confirmed the information via staff roster. On todays visit LPA observed 4 care giving staff and 1 med tech working in the memory care unit providing assistance and meals to residents in care. Based on the interviews conducted with clients and staff as well as observations and record review, the investigation revealed; although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED

Continued on LIC 9099-C
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 28-AS-20220526134147
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: SAGE GLENDALE SENIOR LIVING
FACILITY NUMBER: 198603413
VISIT DATE: 02/13/2023
NARRATIVE
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In regards to the allegation "Staff told Resident to use their diaper instead of assisting them to the bathroom." it was alleged that R1 needed assistance to use the restroom but staff denied helping and told R1 to use their diaper instead. (6) of (6) staff interviewed denied the allegation. (5) of (5) Residents interviews could not corroborate the allegation. LPA was not provided with a name of which staff refused to assist R1. LPA not provided when a date of the incident occurred. Interviews with staff do not show knowledge of any staff speaking to R1 in this manner. Based on the interviews conducted, the investigation revealed; although, the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED

Exit interview conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose VillalobosTELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4