198603413-7-3-2024-31-AS-RVAA-D6TVK8-20240703162954

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198603413
Report Date: 07/03/2024
Date Signed: 07/03/2024 04:30:23 PM

Document Has Been Signed on 07/03/2024 04:30 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:	SMITH,ANGELA		FACILITY TYPE:	740
ADDRESS:	525 W ELK AVE		TELEPHONE:	(818) 245-6378
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91204
CAPACITY:	113	CENSUS: 69	DATE:	07/03/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Angela Smith, Administrator		TIME COMPLETED:	04:30 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	Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced 1 year required inspection visit. LPA met with the Administrator Angela Smith and explained the reason for today's visit. This is an RCFE with a capacity of 113, The census is currently 69. The facility is a 5 story building with underground parking. The 1st floor consists of the following: a lobby area, administrative offices, dinning area, activities room, T.V. room, kitchen, theater, conference room and outdoor patios. The 2nd floor is for Memory Care. The 3rd to 5th floor is for Assisted Living. The passageways and walkways are free of hazards and free from obstruction. The facility also counts with two operable elevators. The facility fire clearance is maintained in conformity with State Fire Marshall regulations. The facility operates and is within capacity limits. Carbon monoxide and smoke detectors were tested and all were operable. No bodies of water were observed in or around the facility. The facility maintains a comfortable temperature of 75 degrees F. Hot water temperature was measured in the kitchen and in resident bathrooms and was within the required 105 degrees F and 120 degrees F. LPA observed the resident rooms to be properly furnished. Centrally stored medicines are kept in the medication room and are locked. There is a functioning call system in each residents' room. Outdoor and indoor passageways were observed to be free and clear of obstructions. Pesticides/poisons are not stored in food areas, kitchen, or where kitchen equipment/utensils are stored. LPA observed there to be a minimum of one (1) week of nonperishable foods and two (2) days of perishable for the number of residents being served. Total daily diet has quality and quantity to meet resident's needs.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

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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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: 07/03/2024

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The smoke detectors are hardwired and interconnected and observed to be operational. There are carbon monoxide detectors in the facility. Fire extinguishers are located throughout the facility and were last serviced in April of 2024 .

The bathrooms were checked for cleanliness and proper operation. LPAs observed the appropriate grab bars in the showers and toilets.

Medications-LPAs observed medication cart in the medication room to be locked and inaccessible to residents. There are eight (8) complete first aid kits.

No health and safety issues noted at the time of this visit.

Exit interview conducted. A copy of this report was issued and signature obtained.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2024

LIC809 (FAS) - (06/04)

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