197607333-2-5-2025-31-AS-NMAN-DFJVJA-20250408162824

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607333
Report Date: 02/05/2025
Date Signed: 02/05/2025 01:10:50 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, 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
11/25/2024 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20241125084432

FACILITY NAME:	GLENDALE GOLDEN YEARS HOME		FACILITY NUMBER:	197607333
ADMINISTRATOR:	AURELIO TRILLANA		FACILITY TYPE:	740
ADDRESS:	1502 LYNGLEN DR.		TELEPHONE:	(818) 484-5693
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91206
CAPACITY:	6	CENSUS: 5	DATE:	02/05/2025
		UNANNOUNCED	TIME BEGAN:	12:04 PM
MET WITH:	Maria Trillana		TIME COMPLETED:	12:05 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not seek timely medical attention for a resident.
Staff did not meet a resident's bathing needs.
Staff intimidates a resident while in care.
Staff speaks inappropriately towards a resident.
Staff inappropriately pushed a resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. LPA met with Administrator, Maria Trillana, and explained the reason for the visit.

---Staff did not seek timely medical attention for a resident.

It was alleged that Resident #1 (R1) had fallen two times in the last week and no medical assistance had been contacted. To investigate the allegation, LPA interviewed one (01) staff and two (02) out of three (03) residents from around 1:30p.m. to 2:15p.m. On 02/05/2025, LPA interviewed two (02) additional staff from 11:00a.m. to 12:00p.m. During interviews with staff, Staff #1 (S1) and Staff #2 (S2) stated R1 came on 11/16/2024 and did not have a fall incident for the duration of her stay.
(CONT. on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
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 3

Control Number 31-AS-20241125084432

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLENDALE GOLDEN YEARS HOME	FACILITY NUMBER: 197607333
	VISIT DATE: 02/05/2025

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
26
27
28
29
30
31
32

Staff #4 (S4) stated they do not know R1. During interviews with residents, all interviewed residents stated they feel that staff would seek timely medical assistance, if needed.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

---Staff did not meet a resident's bathing needs.

It was alleged that Staff #2 (S2) gave R1 a cold shower and had not bathed R1 in over one (01) week since R1’s arrival. To investigate the allegation, LPA conducted a physical plant tour at around 1:00p.m., interviewed one (01) staff and two (02) out of three (03) residents from around 1:30p.m. to 2:15p.m. On 02/05/2025, LPA interviewed two (02) additional staff from 11:00a.m. to 12:00p.m. During the physical plant tour, LPA observed that all residents were clean and well-groomed and did not experience any malodor in the facility. During interviews with staff, all staff stated all residents are bathed two (02) to three (03) times a week. S1 and S2 added that R1 would often refuse bathing. During interviews with residents, all interviewed residents stated their bathing and hygiene needs are being met.

Based on observations and interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

---Staff intimidates a resident while in care.

It was alleged that Staff #3 (S3) gets frustrated and clinches their fist at R1. To investigate the allegation, LPA interviewed one (01) staff and two (02) out of three (03) residents from around 1:30p.m. to 2:15p.m. On 02/05/2025, LPA interviewed two (02) additional staff from 11:00a.m. to 12:00p.m. During interviews with staff, all staff stated they get along with all residents and do not physically intimidate them. During interviews with residents, all interviewed residents stated staff do not intimidate or get frustrated with them.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.
(CONT. on LIC9099-C)

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
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)

Page: 2 of 3

Control Number 31-AS-20241125084432

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: GLENDALE GOLDEN YEARS HOME	FACILITY NUMBER: 197607333
	VISIT DATE: 02/05/2025

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
26
27
28
29
30
31
32

---Staff speaks inappropriately towards a resident.

It was alleged that S3 tells R1 to "shut up" when requesting to be changed. To investigate the allegation, LPA interviewed one (01) staff and two (02) out of three (03) residents from around 1:30p.m. to 2:15p.m. On 02/05/2025, LPA interviewed two (02) additional staff from 11:00a.m. to 12:00p.m. During interviews with staff, all staff stated they do not speak inappropriately to residents or tell them to shut up. During interviews with residents, all interviewed residents stated staff treat them with dignity and respect.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

---Staff inappropriately pushed a resident.

It was alleged that S2 placed their hand on R1’s head and shoulder and pushed R1 aggressively into the bed or sheets. To investigate the allegation, LPA interviewed one (01) staff and two (02) out of three (03) residents from around 1:30p.m. to 2:15p.m. On 02/05/2025, LPA interviewed two (02) additional staff from 11:00a.m. to 12:00p.m. During interviews with staff, all staff stated they do not handle residents inappropriately or in a rough manner and have never physically abused or assaulted any residents. During interviews with residents, all interviewed residents stated staff are gentle and do not physically abuse them.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards noted during the visit.

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

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Abeye Duguma
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)

Page: 3 of 3