Glen Terra Assisted Living

Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegation above. LPA met with administrator Carlos Lara and the purpose of the visit was discussed. Initial visit was conducted on 2/24/22 by LPA Kruz and consisted of the following: LPA obtained and reviewed a copy of the Staff Schedule (August, September, October and December 2021), Resident Roster, Resident #1's records (Physician report, Medical History, Resident Appraisal, Appraisal/Needs and Services Plan, Identification and Emergency Information). On todays visit, LPA Villalobos toured the physical plant and interviewed Staff #1-#5 (S1-S5) and residents #2-#8 (R2-R8) , LPA unable to interview R1 as they are not available for to be interviewed. The investigation revealed the following: Continued on LIC 9099-C UnsubstantiatedRead the full finding— CDSS inspection report, July 27, 2023 · control 28-AS-20220217112823

Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegation above. LPA met with Administrator Carlos Lara and the purpose of the visit was discussed. Initial visit was conducted on 5/13/21 by LPA Kruz and consisted of the following: LPA obtained a copy of the staff and resident roster, hospice agency information and interviewed Staff #1 and Staff #2. On todays visit, LPA Villalobos toured the physical plant and interviewed Staff #3-#5 (S3-S5) and residents #2-#8 (R2-R8) , LPA unable to interview R1 as they are not available for to be interviewed. The investigation revealed the following: Continued on LIC 9099-C SubstantiatedRead the full finding— CDSS inspection report, July 27, 2023 · control 28-AS-20210504155709

Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation visit for the allegation above. LPA met with Administrator Carlos Lara and the purpose of the visit was discussed. Initial visit was conducted on 12/7/21 by LPA Wesley and consisted of the following: LPA toured the physical plant did not observe there to be any health and safety concerns. LPA Wesley requested a copy of: staff roster, resident roster, and the following documents for resident #1 Admission agreement, Emergency Identification page(ID Page), current Physicians report, and the Appraisal needs and services plan. LPA Wesley interviewed Staff #1-#2 (S1-S2). On todays visit, LPA Villalobos toured the physical plant and interviewed Staff #1-#5 (S1-S5) and residents #2-#8 (R2-R8) , LPA unable to interview R1 as they are not available for to be interviewed. The investigation revealed the following: Continued on LIC 9099-C UnsubstantiatedRead the full finding— CDSS inspection report, July 27, 2023 · control 28-AS-20211206101003

***This report is a corrected version of the report dated 04/04/2023 due to a correction needed to the LIC9099D. Citation 87466 was incorrectly issued as a Type B citation, citation should have been issued as a Type A. The other citation 87405(d)(1) on report dated 04/04/23 was issued correctly. No other changes were made to the report. The complaint investigation findings remain Substantiated.*** Licensing Program Analyst (LPA) Christine Wong conducted an unannounced complaint subsequent visit to render finding for the above allegation. LPA met with Receptionist Cecilia Espinoza and explained the reason of the visit. Shortly after, LPA met with Health and Wellness Director Anna Tupinyan and assisted with the visit. The investigation consisted of the following: On 3/29/2022, LPA conducted an initial complaint visit and a health and safety check. LPA toured the facility with Administrator and observed that the facility is clean and in good repair. LPA also observed supplies of nonperishRead the full finding— CDSS inspection report, June 2, 2023 · control 28-AS-20220328103723

At 11:05 am. on 04/20/2023, Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with the Administrator and disclosed the reason for the visit. LPA and S2 toured the facility at 2:30 p.m. No immediate health or safety concerns were observed. Regarding the allegation “Staff did not safeguard resident's personal belongings”, it was alleged Staff #1 (S1) took the purse of Resident #1 (R1). LPA interviewed staff, R1, and R1’s friend between 1:00 p.m. and 2:45 p.m. and reviewed records between 2:00 p.m. and 2:45 p.m. on 04/20/2023. Information obtained through interviews and record review revealed S1 was not a facility staff. S1 was a private caregiver hired by R1. R1 and R1’s friend confirmed that R1 found their purse this morning and the allegation was untrue. Based on interviews and record review, the allegation is deemed UNSUBSTANTIATED at this time. UnsubstantiatedRead the full finding— CDSS inspection report, April 20, 2023 · control 31-AS-20230418170420

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced complaint subsequent visit to render finding for the above allegation. LPA met with Receptionist Cecilia Espinoza and explained the reason of the visit. Shortly after, LPA met with Health and Wellness Director Anna Tupinyan and assisted with the visit. The investigation consisted of the following: On 3/29/2022, LPA conducted an initial complaint visit and a health and safety check. LPA toured the facility with Administrator and observed that the facility is clean and in good repair. LPA also observed supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days. Restrooms, handwashing basins, toilets and bathtub/showers are operable. There are no immediate health and safety concerns. The following documents were collected which included: staff and resident roster and documents for Resident#1-#3. (See LIC 9099C for continuation) SubstantiatedRead the full finding— CDSS inspection report, April 4, 2023 · control 28-AS-20220328103723

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit regarding the allegations listed above. LPA met with Administrator, Carlos Lara, and explained the purpose of the visit. The investigation consisted of the following: On 9/11/2020, LPA J. Katrdzhyan conducted the initial visit and requested for documents pertaining to Resident #1. On 3/14/23, LPA Chan did a follow up visit to interview the Administrator, 6 Staff, 9 Residents, and a Nutrition Consultant. The investigation revealed the following: Allegation - Facility did not meet the resident's dietary needs. It was alleged that Resident #1 (R-1) required a heart healthy diet which was ordered by the physician. According to the Administrator and kitchen staff, the cardiac or heart healthy diet means that the sodium should be limited to the resident. UnsubstantiatedRead the full finding— CDSS inspection report, March 14, 2023 · control 28-AS-20200904141947

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 Carlos Lara, Administrator 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 155 non - ambulatory residents, of which, 4 can be bedridden and has a hospice waiver for 20 residents. Facility is 4-stories in height, with a lobby, dining room located on the main floor, 2 activity rooms, kitchen, a small outdoor shaded patio, medication room located on the second floor, and a salon. LPA Agard conducted interviews and reviewed records on 01/18/2023 and 01/19/2023. Cont. on 9099C UnsubstantiatedRead the full finding— CDSS inspection report, February 22, 2023 · control 28-AS-20230117091626

Licensing Program Analyst (LPA) Angelica Rea conducted a visit in response to the above allegations. On today's visit, LPA met with Administrator Carlos Lara, who assisted with the visit. The investigation consisted of the following: Interview(s) with Administrator, Staff #1 - Staff #3, Resident #1, Resident #1's son, Resident #1's companion, and review of resident #1's file. Regarding the allegation that resident #1 is left unattended and that facility staff did not accompany resident #1 to the hospital, the investigation revealed that resident #1 has lived at the facility since October 9, 2021. Resident #1 experienced a fall on 8/9/22, when she was going to a doctor appointment on her electric wheelchair. Resident #1 suffered a fractured tibia and was hospitalized. Review of resident #1's physician's report does not indicate that resident #1 is not able to leave the facility unassisted. Administrator and facility staff interviewed stated that resident #1 always refuses to have any faRead the full finding— CDSS inspection report, December 5, 2022 · control 28-AS-20221129161405

Licensing Program Analyst (LPA) Cynthia Chan conducted a subsequent visit to deliver the finding for the allegation listed above. LPA met with Administrator, Carlos Lara, and explained the purpose for the visit. The investigation consisted of the following: On 9/23/21, LPA Chan conducted the initial visit. LPA toured the facility with Administrator Lara and selected 10 residents' rooms to inspect. There were adequate food supplies of 2 days perishable and at least a week of non-perishable. LPA did not observe any health and safety concerns during the visit. LPA obtained copies of the staff roster, resident roster, and documents pertaining to Resident #1. The Department of Social Services Investigations Branch (IB) Investigator Peter Zertuche conducted a further investigation. (continue on LIC9099C) UnsubstantiatedRead the full finding— CDSS inspection report, October 27, 2022 · control 28-AS-20210922155543

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA met with Carlos Lara Administrator and explained the reason for the visit. The investigation consisted of the following: On 1/28/22 , LPA Chan toured the facility and gathered a copy of the staff roster, resident roster, and the housekeeping schedule for a week. On 7/19/22 LPA Flores conducted a tour of rooms #201,202,208,301,302,304, 401,402,404,406, alley/waste - trash containers/septic tank area, interview resident #1(R1),#2(R2),#3(R3),#4(R4),#5(R5),#6(R6),#7(R7),#8(R8),#9(R9),#10(R10), administrator (S1), staff #2(S2),#3(S3),#4(S4),#5(S5). The investigation revealed the following: Regarding allegation: Resident's apartment smells malodorous. It is alleged apartment smells like sewage and that the smell is making resident sick. Interviews with residents revealed 6 out of 10 residents stated they have not experienced malodorous smells in their rRead the full finding— CDSS inspection report, July 19, 2022 · control 28-AS-20220125164903

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPA met with Administrator Carlos Lara and explained the reason for the visit. The investigation consisted of the following: LPA obtained a copy of the residents and staff rosters, conducted a tour of room number 126, and interviewed the Administrator, Resident 1 (R1), and R1's Social Worker. The investigation revealed the following: regarding the allegation "staff removed resident's personal belongings without permission", it is alleged that the facility staff removed an electrical burner from R1's room without permission. Interviews conducted with R1 and social worker revealed that it was not the staff that removed the electrical burner. R1's power of attorney (POA) removed the electrical burner and did not notified the facility. The social worker found out it was the POA yesterday during a telephone meeting. (CONTINUED TO LIC 9099C) UnsubstRead the full finding— CDSS inspection report, July 19, 2022 · control 28-AS-20220715161618

On 04/22/2022 approximately 10:30 am, Licensing Program Analyst (LPA) Gail Johnson and Licensing Program Manager (LPM) Ulysses Coronel arrived at Glen Terra Assisted Living and conducted an unannounced complaint investigation. LPA and LPM met with Administrator Carlos Lara and the purpose of the visit was explained. The investigation consisted of the following: On 08/10/2021 LPA Bonnie Tao interviewed five (5) staff and one (1) resident. LPA Tao obtained a copy of staff records and resident records. On 04/22/2022, LPA Johnson and LPM Coronel interviewed toured the facility, reviewed facility and client R1’s records and interviewed administrator Lara. Report continues on LIC9099-C. SubstantiatedRead the full finding— CDSS inspection report, April 22, 2022 · control 28-AS-20210802105346

Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial complaint investigation visit for the above allegations. LPA Irra met with Carlos Lara (Facility Administrator) and Tony Rios (Director of Communication Relations) and discussed the purpose of today’s visit. During this investigation, LPA interviewed Staff #1 through Staff #5. LPA also interviewed Resident #1 (R-1) and reviewed R-1’s file and obtained relevant documentation. LPA was unable to interview Resident #2 (R-2) as R-2 is non-verbal. Refer to LIC 9099C for the continuation of this report. Unsubstantiated— CDSS inspection report, April 21, 2022 · control 28-AS-20220414141042

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent complaint visit to finish investigation into the allegation above. LPA met with the administrator and explained the reason for this visit. LPA conducted a physical plant tour to ensure no immediate health and safety issues from 10:45-11:15pm. No immediate health and safety issues were noted. LPA observed staff to be wearing mask throughout the facility and hand sanitizers were available throughout the facility. LPA conducted the intial visit on 4/1/2020 where interview was done with the administrator. It is alleged that facility staff failed to wear mask consistently around the facility and were not ensuring that residents were social distancing from one another. Since this complaint came in facility had an annual visit on 8/3/21 and a case management visit on 10/5/21. During both visits it was noted that staff were not wearing mask properly and that residents were not observed to be social distancing byRead the full finding— CDSS inspection report, April 12, 2022 · control 31-AS-20200325144834

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegation listed above. LPA arrived unannounced and met with Carlos Lara, the Administrator. The purpose of the visit was explained. The investigation consisted of the following: LPA Chan toured the facility with the Administrator. LPA obtained copies of the staff and resident rosters, COVID-19 Mitigation Report, and In-Service training logs. LPA also interviewed the Administrator, 7 Staff, and 10 Residents. The investigation revealed the following: Regarding allegation, Facility is not following COVID-19 outbreak guidance. LPA toured the facility and observed the following pertaining to the allegation: The Staff are all wearing their surgical/N95 masks correctly. SubstantiatedRead the full finding— CDSS inspection report, January 28, 2022 · control 28-NP-20220125080926

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation for the allegations listed above. LPA arrived unannounced and met with Carlos Lara, the Administrator. The purpose of the visit was explained. The investigation consisted of the following: LPA Chan toured the facility with the Administrator. LPA obtained copies of the staff and resident rosters, COVID-19 Mitigation Report, and In-Service training logs. LPA also interviewed the Administrator, 7 Staff, and 10 Residents. The investigation revealed the following: Regarding allegation - Facility is not reporting the Coronavirus (COVID-19) cases. Based on the interviews with the Administrator and Staff, they all indicated that if there are positive COVID-19 cases at the facility, everyone is informed. Staff are aware of the recently confirmed positive case. (Continue on LIC9099C) UnsubstantiatedRead the full finding— CDSS inspection report, January 28, 2022 · control 28-NP-20220125080926

Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint visit in response to the above allegations. LPA met with Administrator, Carlos Lara, Director of Community relations, Tony Rios who assisted with today's visit. Regarding the allegation that residents are being subjected to second -hand smoke, the investigation consisted of interviews with Licensee, Administrator, Director of community relations and resident #1 - resident #8. Staff interviewed stated that they have been notified by some residents that resident #1 has smoked in his room. Staff stated that smoking is not allowed in the facility. Staff interviewed said that there is a designated smoking area on the patio, and they have reminded resident #1 that smoking in resident rooms is not permitted. Resident #1 denied that he smokes in his room. He stated that he is aware of the house rules, and complies with them. 8 out of 8 residents interviewed, stated that they are not being subjected to second hand sRead the full finding— CDSS inspection report, December 30, 2021 · control 28-AS-20211223152217

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit to investigate the above allegation. LPA met with Administrator Carlos Lara and explained the reason of the visit. The investigation consisted of the following: LPA obtained copies of Resident & Staff Rosters, Admission Agreement, House Rules, Physicians Report and Resident Appraisal for Resident #1. LPA interviewed Staff #1 - Staff #5 and Resident #1 - Resident #9. LPA also toured the facility which included the common areas and random sample of resident rooms. The investigation revealed the following: in regards to the allegation "resident smoking at the facility where oxygen is in use", it is alleged that there are residents in the 2nd floor of the facility that are smoking in their rooms. Interview conducted with Administrator revealed that residents are not allowed to smoke in their rooms. There is a designated smoking area in the facility which is located in the front of the facility. (CONTINURead the full finding— CDSS inspection report, December 1, 2021 · control 28-AS-20211124164511

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced complaint visit to investigate the above allegations. LPA met with Administrator, Carlos Lara and explained the reason of the visit. The investigation consisted of the following: LPA interviewed ten residents (R1-R10), administrator and five (5) staff (S1-S5) and obtained copy of the documents included residents roster, faciltiyn dining service menu, R1's Identifiction and Emeregency Information, Admission Agreement, Physician Report. Appraisal/Needs and Service Plan, Resident Appraisal and 30 day eviction notice dated on 10/9/2021. The investigation revelaed of the following: Allegation#1 "Staff threatened to evict resident illegally." LPA interviewed ten residents and nine residents reported there are no staff ever threatened them. (See LIC9099C for continuation) UnsubstantiatedRead the full finding— CDSS inspection report, November 23, 2021 · control 28-AS-20211115134302

This report supersedes report created on 8/10/21 to correct resident #1 to resident #4 and residents' interview finding. On 8/10/21 Licensing Program Analyst(s) (LPA) Mary Flores conducted an unannounced complaint investigation regarding the above allegation. LPA Flores met with Jessica Almendarez receptionist and explained the reason for the visit. Administrator Carlos Lara arrived an hour later. The investigation consisted of the following: LPA Flores requested staff/resident roster, interviewed executive director, wellness director, staff #1(S1),#2(S2),#3(S3),#4(S4),#5(S5), and residents #1(R1),#2(R2), #3(R3),#4(R4),#5(R5),#6(R6),#7(R7),#8(R8), reviewed residents files and requested copies of needs and care plan, physician's report, and care notes for all 8 residents. The investigation revealed the following: Regarding allegation: Resident's colostomy bag is not being regularly changed. It is alleged facility doesn't change resident's colostomy bags timely and bag had not been changRead the full finding— CDSS inspection report, October 5, 2021 · control 28-AS-20210806114742

Licensing Program Analyst (LPA) Jose Villalobos conducted a subsequent complaint investigation regarding the above allegation. LPA Villalobos met Administrator Carlos Lara and explained the reason for the visit. The investigation consisted of the following: LPA Villalobos requested staff/resident roster, interviewed staff #1-#5 (S1-S5), and residents #1-#6 (R1-R6), LPA toured the facility and observed rooms #111, # 222, #325 and #402. The investigation revealed the following: In regards to the allegation, "Facility is not providing comfortable living accommodations to resident " it was alleged that residents with wheelchairs could not access the bathrooms sinks. (5) of (5) staff interviewed denied the allegation. (6) of (6) residents interviewed could not corroborate the allegation. LPA observed that each resident room has a private bathroom... Continued on LIC 9099-C UnsubstantiatedRead the full finding— CDSS inspection report, September 22, 2021 · control 28-AS-20191127133704

Licensing Program Analysts (LPAs) Nune Margaryan and Tony Vasallo conducted subsequent visit to the facility to further investigate the above noted allegation. LPAs met with Administrator Carlos Lara and explained the purpose of this visit. It was alleged that facility resident #1’s (R1’s) personal property was stolen at the facility. The stolen items include wedding ring and “stimulus card”. The initial visit was conducted by LPA Joe Katrdzhyan on 04/21/21. During the visit LPA Joe Katrdzhyan obtained the following documents: • Admission Agreement • Pre-placement Appraisal Information • Appraisal/Needs and Services Plan • Physician's Report • Functional Capability Assessment • Client/Resident Personal Property and Valuables Form • Resident Roster • Staff Roster Today's investigation consisted of the following: Request Resident's and staff roster; obtained theft and loss policy, interviewed five (5) staff and eight (8) residents. con. 9099C UnsubstantiatedRead the full finding— CDSS inspection report, August 27, 2021 · control 28-AS-20210412091729

Licensing Program Analyst(s) (LPA) Mary Flores conducted an unnounced complaint investigation regarding the above allegation. LPA Flores met with Jessica Almendarez receptionist and explained the reason for the visit. Administrator Carlos Lara arrived an hour later. The investigation consisted of the following: LPA Flores requested staff/resident roster, interviewed executive director,wellness director, staff #1(S1),#2(S2),#3(S3),#4(S4),#5(S5), and residents #1(R1),#2(R2), #3(R3),#4(R4),#5(R5),#6(R6),#7(R7),#8(R8), reviewed residents files and requested copies of needs and care plan, physician's report, and care notes for all 8 residents. The investigation revealed the following: Regarding allegation: Resident's colostomy bag is not beign regularly changed. It is alleged facility doesn't change resident's colostomy bags timely and bag had not been changed in 14 hours and was starting to leak. During interviews with residents 2 out of 8 residents stated to not need assistance from nurseRead the full finding— CDSS inspection report, August 10, 2021 · control 28-AS-20210806114742

Licensing Program Analyst (LPA) Jose Villalobos initiated a complaint investigation for the allegation(s) listed above. Today’s complaint investigation was conducted with Administrator Carlos Lara and purpose of the visit was discussed. Today's investigation consisted of the following: LPA Villalobos interviewed staff #1-#4 (S1-S5) and residents #1-#6 (R1-R6). LPA also obtained and reviewed copies of the following documents in reference to R1; Admission Agreement • Pre-placement Appraisal Information • Appraisal/Needs and Services Plan • Physician's Report • Resident Roster • Staff Roster Todays investigation revealed the following: In regards to the allegation " Staff did not assist resident with their medication in a timely manner" it was alleged that staff took more than an hour to provide R1 with their medication on 7/16/21 after reaching out to them. Continued on LIC 9099-C UnsubstantiatedRead the full finding— CDSS inspection report, July 21, 2021 · control 28-AS-20210716081320