197608685-10-19-2021-31-AS-NGID-C9GW22-20211207155338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 10/19/2021
Date Signed: 10/19/2021 12:31:09 PM

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
07/19/2019 and conducted by Evaluator Patrick Shanahan

COMPLAINT CONTROL NUMBER: 31-AS-20190719090527

FACILITY NAME:	ATRIA SANTA CLARITA		FACILITY NUMBER:	197608685
ADMINISTRATOR:	JOHNNY ORTIZ		FACILITY TYPE:	740
ADDRESS:	24431 LYONS AVE		TELEPHONE:	(661) 254-9933
CITY:	SANTA CLARITA	STATE: CA	ZIP CODE:	91321
CAPACITY:	160	CENSUS: 114	DATE:	10/19/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Johnny Ortiz/ Administrator		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility staff failed to meet resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Patrick Shanahan, arrived at the facility in response to the above mentioned allegations. LPA had his temperature checked, COVID-19 related questions asked and vaccine verification requested before being allowed entry.

Allegation 1. Facility staff failed to meet resident's needs
At about 9:30 AM, the LPA was able to tour the facility in response to this allegation. At 9:45 AM, LPA began interviewing residents in the memory care portion of the facility. At 10:15 AM, LPA was able to speak with the resident in question (R1) regarding the allegation. R1 indicated that the staff are very nice and will assist R1 anytime R1 requires assistance. R1 also indicated that R1 feels safe at the facility and believes that staff will assist R1 in an emergency. LPA was also able to interview 6 other residents in memory care who also indicated that staffing is sufficient and that they feel safe. All residents questioned, stated that they feel safe and that the staff are able to meet their needs.
Continues on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20190719090527

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: ATRIA SANTA CLARITA	FACILITY NUMBER: 197608685
	VISIT DATE: 10/19/2021

NARRATIVE

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At 11:00 am, LPA was able to interview the staff in the memory care portion of the facility. Staff indicated that there are always 4 staff available during the day and PM shifts to assist with residents needs. A review of the staffing schedule, conducted at 11:30 AM, indicated that there are at least 4 staff working the memory care portion during the day and PM shifts and 3 staff working the overnight shift. All staff staff interviewed feel that they are able to meet the needs of all the residents in care.

Based on interviews with residents and staff, as well as a review of the staffing schedule, this allegation is deemed to be Unsubstantiated at this time.

Exit interview conducted and report issued.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick Shanahan	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 10/19/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2021

LIC9099 (FAS) - (06/04)

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