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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 02:13:13 PM

Document Has Been Signed on 02/10/2025 02:13 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:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Peter Bonilla, Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
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At 10:30 a.m. on 02/10/2025 Licensing Program Analyst (LPA) Antonia Alvizar-Etitma conducted an unannounced case management visit. LPA met with Executive Director, Peter Bonilla and disclosed the reason for the visit.

Today’s case management visit was conducted to ensure the safety and welfare of evacuees from the RCFE- Continuing Care Retirement Community Montecedro (LIC# 197610430), due to Eaton Fire. At 11:15a.m. E.D. and LPA toured the facility. At approximately 11:50a.m. LPA interviewed four (04) out of five (05) residents from Montecedro. Interviews with residents reveal that they are doing well, Sage Glendale is meeting their needs and Montecedro is providing the service. LPA was not able to interview a resident because they were out of the community with family at the time of this visit. LPA observed all residents well kept, clean and groomed.

No immediate health or safety hazards were observed during today’s visit.

Exit interview conducted. Copy of report provided.

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)
Page: 1 of 2
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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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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