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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603413
Report Date: 02/10/2025
Date Signed: 02/10/2025 03:56:23 PM

Document Has Been Signed on 02/10/2025 03:56 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 LIVINGFACILITY NUMBER:
198603413
ADMINISTRATOR/
DIRECTOR:		SMITH,ANGELAFACILITY TYPE:
740
ADDRESS:525 W ELK AVETELEPHONE:
(818) 245-6378
CITY:GLENDALESTATE: CAZIP CODE:
91204
CAPACITY: 113CENSUS: 81DATE:
02/10/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Peter Bonilla, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Antonia Alvizar-Ettima conducted an unannounced Required One (1) year inspection visit at this facility today. LPA met with Executive Director and explained the reason for the visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools.

At 11:15a.m. LPA and E.D. toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. This is an RCFE with a capacity of 113, The census is currently 81. The facility is a five (05) story building with underground parking. The 1st floor consists of the following: a lobby area, administrative offices, dining 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 maintains a comfortable temperature at 75°F. There are carbon monoxide detector installed in the facility. Fire extinguishers are located all throughout the facility and last inspected on 04/25/2024. The fire extinguishers and carbon monoxide detectors were observed to be fully charged and in compliance. The facility is equipped with emergency pull alarm and sprinkler system. Facility Fire drill was last conducted on 01/08/2025.

There is only one entrance being utilized at the facility, all required posters were posted at the entrance. The facility has central air and heating accommodations. During today's visit, in addition to the physical plant inspection LPA interviewed eight (08) out of eighty-one (81) residents.



A tour of the physical plant was conducted and the following was noted:
Kitchen: The kitchen appliances and fixtures were functional. Food supplies was sufficient amount for two (02) days of perishable and seven (07) days of non-perishable was stored in covered containers at the appropriate temperatures.

Cont. on LIC 809-C

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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: 02/10/2025
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Knives and sharp objects were observed to be locked and inaccessible to residents. Storage areas for cleaning solutions, toxics, knives, and hazardous items were secured and made inaccessible to residents. Walls, ceiling, and floor is in good repair, ample supply of dishes, cups, glasses and utensils for the current census.

Dining area: The dining area was observed to be neat, clean and in proper order. Walls, ceiling, tables, chairs and floor is in good repair.Laundry rooms: There are laundry rooms located on each floor of the building. All toxins such as laundry detergents, cleaning agents were observed to be inaccessible to the residents in laundry rooms.

Medication: Medications are centrally stored in the locked medication stations located on floors two and three. The medications were observed to be locked and inaccessible to residents. There are multiple complete first aid kits in the facility.


Bedrooms: LPA randomly selected resident’s apartments on each floor. Resident bedrooms were properly furnished with appropriate beddings and linens with sufficient lighting. Hygiene for residents was observed and hallways/passageways are lit. There were enough clean linen available in the closets. Each resident’s apartment has their own restroom.

Bathrooms: LPA randomly selected resident’s bathrooms on each floor. The bathrooms were observed to be clean properly supplied, functional fixtures and appropriate grab bars in showers and toilets. The hot water temperature measure range was between 106.3 – 119.3 degrees Fahrenheit within Title 22 Regulations.


Common Areas: LPA observed common areas on every floor. All furnishings are in good repair, lighting is good, walls, ceiling and floors are also in good repair.

Surrounding Grounds: The front grounds of the facility are well landscaped and have a leveled walkway to the entrance. All passageways were observed to be clear from obstruction. The outdoor area was enclosed, and no bodies of water were observed.



Due to time constraints, LPA had to terminate the visit and will return on a later date to complete the Required - 1 Year inspection by reviewing medication, residents and staff records.

No health and safety issues noted at the time of this visit.
An exit interview was conducted. A copy of this report was provided to the Executive Director.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Antonia Alvizar-Ettima
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2025
LIC809 (FAS) - (06/04)
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