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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197610587
Report Date: 07/17/2025
Date Signed: 07/17/2025 02:50:22 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
12/20/2024 and conducted by Evaluator Angela Panushkina
COMPLAINT CONTROL NUMBER: 31-AS-20241220164846
FACILITY NAME:ASSISTED LIVING ON GLADE LLCFACILITY NUMBER:
197610587
ADMINISTRATOR:SIPAN MOVSESYANFACILITY TYPE:
740
ADDRESS:10140 GLADE AVETELEPHONE:
(818) 696-3110
CITY:CHATSWORTHSTATE: CAZIP CODE:
91311
CAPACITY:6CENSUS: 5DATE:
07/17/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Nina Blayan, Designee TIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility staff refuse visitor(s)
INVESTIGATION FINDINGS:
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At 09:30am, Licensing Program Analyst (LPA) Angela Panushkina conducted an conducted a subsequent visit to deliver the final finding. LPA met with the Designee, Nina Blayan, and explained the reason for the visit.

During the initial visit conducted on 12/27/24, course of the investigation, interviews and record review were made. At 11:45am, LPA requested copies of pertinent information which include, but not limited to Admission Agreement, Physician’s Report, Appraisal Needs and Services Plan, Visitors Sign in Sheet, etc., relevant to the investigation. At approximately 11:50am, LPA conducted a physical plant tour, to ensure health and safety of the residents are protected and physical plant is in compliance with Title 22 Regulations. Between 12:00pm – 12:30pm, LPA conducted an interview with the Designee, two (2) staff, and two (2) out of four (4) residents, who were able to communicate. LPA also conducted an interview with R1's Conservator.
Continue on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
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-20241220164846
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: ASSISTED LIVING ON GLADE LLC
FACILITY NUMBER: 197610587
VISIT DATE: 07/17/2025
NARRATIVE
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Allegation: Facility staff refuse visitor(s)

It was alleged that R1's son was not allowed to visit R1. To investigate this allegation, LPA conducted interviews with the Designee and two (2) staff members. The interview with the Designee revealed that in December 2024 due to the peak of influenza season, as a precaution the facility notified family members to limit visitations. Two staff members interviewed corroborated with the statement provided by the Designee. Additionally, two (2) out of four (4) residents interviewed expressed no concern regarding this allegation and informed LPA that visitation has never been an issue at this facility. Interview with the Conservator revealed that he/she was well aware of the situation (changes, visiting hours, etc.) and also expressed no concerns regarding this allegation. Lastly, review of the facility "Visiting Sing In Sheet" revealed that from 12/01/2024 to 12/27/2024 all residents had visitors. LPA also observed that R1's son visited R1 every day or every other day. Based on interviews and file/document reviews this allegation is deemed Unsubstantiated at this time.

Exit interview conducted appeal rights explained and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 07/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2