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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603413
Report Date: 04/26/2024
Date Signed: 04/26/2024 01:30:14 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/07/2023 and conducted by Evaluator Jose Gary Tan
COMPLAINT CONTROL NUMBER: 28-AS-20230407154205
FACILITY NAME:SAGE GLENDALE SENIOR LIVINGFACILITY NUMBER:
198603413
ADMINISTRATOR:SMITH,ANGELAFACILITY TYPE:
740
ADDRESS:525 W ELK AVETELEPHONE:
(626) 253-2929
CITY:GLENDALESTATE: CAZIP CODE:
91204
CAPACITY:113CENSUS: 60DATE:
04/26/2024
UNANNOUNCEDTIME BEGAN:
09:27 AM
MET WITH:Angela Monette-Smith -Executive DirectorTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility took payment but did not admit resident to facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation. LPA met with Executive Director Angela Monette-Smith and explained the reason for the visit.

LPA conducted physical plant tour at 9:56 AM, requested copies of facility documents relevant to the investigation at 10:40 AM, interviewed the Executive Director at 11:00 AM and reviewed records between 11:30 AM to 12:15 PM. It was alleged that Resident #1 (R1)'s family member paid over $9,000.00 to the facility for R1 to be admitted at this facility but was not admitted. LPA's record review today between 11:30 AM to 12:15 PM revealed that it was the family member of R1 who decided not to move R1 to the facility. Further review also revealed that the family member of R1 paid a total of $9250.00 to the facility on 03/09/23 and demanded a refund on 04/12/23.

(continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
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 2
Control Number 28-AS-20230407154205
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: SAGE GLENDALE SENIOR LIVING
FACILITY NUMBER: 198603413
VISIT DATE: 04/26/2024
NARRATIVE
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(continued from LIC 9099)

The facility was about to refund the money to R1's family member on 04/14/23 but the check payment made by R1's family already bounced at that time, so no refund check was issued.

Based on the information gathered during this and prior visit. The allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary TanTELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2