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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 03/11/2022
Date Signed: 03/11/2022 03:52:17 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
03/09/2020 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20200309111042
FACILITY NAME:ATRIA SANTA CLARITAFACILITY NUMBER:
197608685
ADMINISTRATOR:JOHNNY ORTIZFACILITY TYPE:
740
ADDRESS:24431 LYONS AVETELEPHONE:
(661) 254-9933
CITY:SANTA CLARITASTATE: CAZIP CODE:
91321
CAPACITY:160CENSUS: DATE:
03/11/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Johnny OrtizTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff locked residents in their rooms.
Residents door is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Abeye Duguma and Gary Tan conducted an unannounced subsequent complaint visit to obtain additional information for the above noted allegations. LPA met with Johnny Ortiz, Executive Director (ED) and discussed the reason for the visit.

---Staff locked residents in their rooms.

It was reported that the resident is being locked in the room. To investigate these allegations, on 03/11/2022 at 2:00pm LPAs conducted a physical plant tour. During the tour, LPAs selected random rooms to inspect and discovered that the rooms may only be locked from the inside. LPAs' interview facility staff between 12:30pm-2:30pm revealed that no one locked any resident inside their rooms at any time. Based on the information gathered during this and prior investigations, the allegation is unsubstantiated at this time.

(CONT on LIC9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye DugumaTELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
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-20200309111042
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: 03/11/2022
NARRATIVE
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--- Residents door is in disrepair

It was reported that the resident's door is in disrepair. To investigate these allegations, on 03/11/2022, between 12:30pm - 2:30pm LPAs conducted interviews and requested pertinent documents. The interviews with facility staff revealed that the resident would often aggressively handle the door, motioning the door handle up and down beyond its intended design limitations and it eventually broke. The pertinent documents reviewed by the LPAs and interviews with facility staff also revealed that a work order was place for repairs on 03/08/2021 at 12:43pm and the door was repaired the following day. Based on the information gather, during this and prior investigations, the allegation is unsubstantiated at this time.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye DugumaTELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:

DATE: 03/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2