197608685-4-6-2022-31-AS-NMAN-CGJPRX-20220721113328

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 04/06/2022
Date Signed: 04/06/2022 05:54:53 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
03/10/2022 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20220310153449

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: 109	DATE:	04/06/2022
		UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Johnny Ortiz		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Resident was overheated.
Resident was dehydrated.
Facility did not have hot water for a week.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility. Upon entry, LPA met with Executive Director (ED), Johnny Ortiz, and explained the reason for the visit.

--- Resident was overheated.

It was alleged that Resident #1 (R1) was in her room with the door shut, and the heater was on full blast. To investigate this allegation, on 03/11/2022 at 9:40 AM, Licensing Program Analysts (LPAs), Abeye Duguma and Gary Tan, conducted a physical plant tour and interviewed staff between 10:15 AM – 11:40 AM. Interviews and observations revealed that the facility staff do not adjust the room’s temperature higher than seventy-eight degrees (78º).

(CONT. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

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-20220310153449

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: 04/06/2022

NARRATIVE

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During the physical plant inspection, LPAs observed the thermostats at a comfortable range of 72 - 75º. During the interviews it was reported that R1 bundles up layers of clothing frequently and often feels cold.
Based on the interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Resident was dehydrated.
It was alleged that Resident #1 (R1) was . To investigate this allegation, on 03/11/2022 at 9:40 AM, Licensing Program Analysts (LPAs), Abeye Duguma and Gary Tan, conducted a physical plant tour and interviewed staff between 10:15 AM – 11:40 AM. Interviews and observations revealed that the resident drinks lots of water and always has a tumbler full of water in the room. LPAs also observed a note on the night stand that read, “drink your water”, a tumbler full of water next to the bed and resident, who was participating in group activities at the time, sitting with a cup full of water.

Based on the interviews and observations, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

---Facility did not have hot water for a week.
It was alleged that the facility did not have hot water for a week. To investigate this allegation, on 03/11/2022 at 9:40 AM, Licensing Program Analysts (LPAs), Abeye Duguma and Gary Tan, conducted a physical plant tour, requested pertinent documents and interviewed staff between 10:15 AM – 11:40 AM. Interviews revealed that the water heater’s ignitor pilot was reported broken on 02/28/2022, that a Work Order was submitted the same day and fixed within a weeks’ time. During the time that the water heater was not in working condition, the residents were transferred to the adjacent building for showering and other hygiene needs. In addition, LPAs selected rooms at random and it was observed that all faucets had hot water during the time of the visit.

Based on interviews and observations, the facility was able to maintain the health, hygiene needs and safety of their resident through alternate means. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards were noted during the visit.
Exit interview was conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2022

LIC9099 (FAS) - (06/04)

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