198603413-2-22-2023-28-AS-NGID-CQKM44-20230404091604

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603413
Report Date: 02/22/2023
Date Signed: 02/22/2023 12:45:46 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,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/17/2023 and conducted by Evaluator Troy Agard

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20230117100006

FACILITY NAME:	SAGE GLENDALE SENIOR LIVING		FACILITY NUMBER:	198603413
ADMINISTRATOR:	BERARD, MARTHA		FACILITY TYPE:	740
ADDRESS:	525 W ELK AVE		TELEPHONE:	(626) 253-2929
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91204
CAPACITY:	113	CENSUS: 55	DATE:	02/22/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Angela Smith		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff did not prevent resident from being sexually abused while in care

INVESTIGATION FINDINGS:

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On 02/22/2023 Licensing Program Analyst (LPA) Troy Agard conducted a subsequent complaint investigation at the above facility to address the following allegations. LPA Agard met with Angela Smith and explained the purpose of this visit was to deliver findings for this complaint.

The investigation consisted of the following: LPA toured the physical plant. The facility is licensed to served 113 residents. The first floor consists of a kitchen, administrative space, theater, bistro, and activities room. The 2nd floor is for Memory Care and the 3rd to 5th floor is for Assisted Living. The facility was observed to be in good repair. Passageways and walkways are free of hazards and obstructions. LPA Agard requested documents that were received at the time of visit. LPA requested a staff and resident roster, and R1’s physician report.

Cont. on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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-20230117100006

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: SAGE GLENDALE SENIOR LIVING	FACILITY NUMBER: 198603413
	VISIT DATE: 02/22/2023

NARRATIVE

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The investigation revealed the following…Regarding the allegation: Staff did not prevent resident from being sexually abused while in care. “It’s being alleged that a resident was touched inappropriately by a male staff at this facility.” LPA attempted interviews with 7 out of 60 staff in total. 0 out of 5 confirmed the allegation. 2 staff were unavailable for an interview. All staff interviewed confirmed knowing R1 and denied any reports of sexual misconduct being reported to them and/or observed. LPA attempted interviews with 2 witnesses. W1 states, “the event did happen based on what was told to them by R1 but is unaware of the alleged perpetrator.” W2 was unavailable for an interview.

LPA attempted interviews with 5 out of 55 residents in total. 0 out of 4 confirmed the allegation. 1 resident was unavailable for an interview. All residents interviewed denied knowing about the alleged allegation. Residents interviewed state that the staff treat them with dignity and respect and denied any sexual misconduct from staff. R1 who was unavailable for an interview on 02/02/2023 was interviewed on 01/31/2023. Per the investigation report from Investigator Zertuche, R1 states, “not remembering the name of the last facility they resided at but recalls not having any issues there. Stating: “I liked it.” Resident denied any abuse and inappropriate touching at the facility.”

During a record review, LPA reviewed the physician report for R1 and observed resident to need support with some activities of daily living which includes being on an incontinent schedule. Physician report also noted a primary diagnosis that could contribute to confusion within the resident.

Based on LPA’s observation, record review and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of the report was given.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

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