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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607333
Report Date: 02/05/2025
Date Signed: 02/05/2025 02:04:23 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.RO, 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
01/31/2025 and conducted by Evaluator Antonia Alvizar-Ettima
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250131124533
FACILITY NAME:GLENDALE GOLDEN YEARS HOMEFACILITY NUMBER:
197607333
ADMINISTRATOR:AURELIO TRILLANAFACILITY TYPE:
740
ADDRESS:1502 LYNGLEN DR.TELEPHONE:
(818) 484-5693
CITY:GLENDALESTATE: CAZIP CODE:
91206
CAPACITY:6CENSUS: 5DATE:
02/05/2025
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Adm., Maria Trillana & Staff, Beverly TaladoTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility staff were not meeting residents incontinent needs.
INVESTIGATION FINDINGS:
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At 9:10a.m. Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced subsequent visit to investigate and deliver finding for the above noted allegation. LPA was greeted by staff #1-#2 (S1-S2) granted LPA entrance and S1 contacted Administrator via phone. At 9:17a.m. S2 and LPA conducted a physical plan tour and interviewed S1-S2. At approximately 9:57a.m. Administrator/Licensee joined and explained the reason for the visit.

At the time of initial visit on 01/31/2025 LPA met with staff #1-#2 (S1-S2) S2 contacted Administrator via phone. Administrator/Licensee joined the visit at 1:30p.m. The purpose of visit was explained. Physical plant tour was conducted, obtained staff contact information and staff and resident rosters.
During today’s visit at 10:15a.m. LPA request and received resident #1 (R1) Physician Report, Preplacement Appraisal, Progress Notes and Daily Vital Records.
Cont. LIC 9099c
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
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 31-AS-20250131124533
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: GLENDALE GOLDEN YEARS HOME
FACILITY NUMBER: 197607333
VISIT DATE: 02/05/2025
NARRATIVE
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Staff training records were requested and received. At 10:35a.m facility records were reviewed, residents and staff were interviewed.

Facility staff were not meeting residents incontinent needs.

It was alleged that staff are not changing R1. Administrator indicated that it was impossible that R1 was not being changed because R1 was alert and able to communicate needs. Staff interviews revealed that incontinent residents are being changed three (03) to four (04) times a day or as needed. LPA conducted interview with staff #1(S1) involved with R1's care. S1 interview revealed that R1’s diaper was always changed otherwise R1 will scream and curse at staff. Other residents revealed that staff changes them three (03) times a day, and more often if needed. LPA was not able to interview resident (R5) due to being non-verbal. Resident (R1) no longer reside at the facility.


The information revealed from records supported the information provided by the facility personnel. At the time of facility inspection, LPA observed residents and they were clean, well-groomed and no one appeared to need changing. LPA also observed the facility to be clean and did not experience any malodor.

Based on observation, interviews and record review, there is no pertinent information to support the allegation. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.


No health and safety hazards noted during this visit.

Exit interview conducted and a copy of the report was issued.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025
LIC9099 (FAS) - (06/04)
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