197608685-10-10-2022-31-AS-RRAZ-CL3NZL-20221111095428

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 10/10/2022
Date Signed: 10/10/2022 03:44:49 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
08/29/2022 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20220829113112

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:	DATE:	10/10/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Johnny Ortiz		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not ensure that resident's hygiene needs were met.
Staff did not provide appropriate incontinent care.
Staff issued an improper eviction notice to resident.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to investigate the above allegations. LPA met with Johnny Ortiz, Executive Director (ED), and discussed the reason for the visit.

--- Staff did not ensure that resident's hygiene needs were met.

It was alleged that resident #1 (R1) was found to be malodorous during a visit by the Reporting Party (RP). To investigate this allegation, on 09/06/2022 at 12:30 PM, LPA interviewed staff and residents, on 10/06/2022 at 01:30 PM, LPA interviewed the Reporting Party (RP). In addition to the interviews, on 10/10/2022 at 12:30 PM, LPA conducted a physical inspection of randomly selected rooms.

(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: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

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-20220829113112

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: 10/10/2022

NARRATIVE

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Interviews with staff revealed that all hygiene needs are being met, that each resident has a shower schedule, are also showered more often if needed, and that caregivers are on standby for those who need assistance. Staff also stated that at times R1 refuses to shower and that they can only encourage R1 to shower but cannot force. During interviews with residents, they all stated (including R1) that their hygiene needs are being met and that they are being showered timely. During interviews with the RP, they stated that R1 was not being showered often enough, smelled at times, but they are also aware that R1 refuses to shower. During observations of residents, LPA found that they all appeared clean, well groomed and did not experience any malodor during the visit.

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

--- Staff did not provide appropriate incontinent care.

It was alleged that resident #1 (R1) is not getting assistance with diapering. To investigate this allegation, on 09/06/2022 at 12:30 PM, LPA interviewed staff and residents and, on 10/06/2022 at 01:30 PM, LPA interviewed the Reporting Party (RP). In addition to the interviews, on 10/10/2022 at 12:30 PM, LPA conducted a physical inspection of randomly selected rooms. Interviews with staff revealed that all incontinent care needs are being met, they change R1’s diaper up to three times a day, but are changing R1 more often, if needed. Staff also stated R1 always requests for two diapers at a time so that in the event they soil one, they may rip it off, discard it, and pull up the clean one. During interviews with the RP, they stated that the facility is not checking on R1 frequently enough and they are not changing the diaper as often as they should. During interviews with residents, they all stated (including R1) that their toileting needs are being met timely. Furthermore, LPA observed residents and found that they all appeared clean and did not see or smell any bodily fluids or waste during the visit.

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

(Cont. on LIC 9099-C)

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20220829113112

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: 10/10/2022

NARRATIVE

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--- Staff issued an improper eviction notice to resident.

It was alleged that resident #1 (R1) was issued an eviction notice. To investigate this allegation, on 09/06/2022 at 12:30 PM, LPA interviewed staff and residents, on 09/06/2022 at 2:30PM, LPA requested pertinent documents and, on 10/06/2022 at 01:30 PM, LPA interviewed the Reporting Party (RP) and requested documents. Interviews with staff revealed that R1 was not issued an eviction notice. During interviews with the RP, they stated that, because they did not agree with certain charges, the facility issued an eviction notice. LPA asked RP to produce this eviction notice but they did not provide one. During interviews with residents, they all stated (including R1) that they have either never been issued an eviction notice or did not know whether they ever have been. Record reviews also confirmed that R1 was not issued an eviction notice. However, according to what was found in the R1’s file and what was provided by the RP, the responsible party failed to pay for a portion of the bill (for higher level of care) and it stated that failure to pay may lead to a termination of services “including potential eviction procedures” and on a different letter for an attempt to collect a debt it stated, if payment is not received “we have no choice but to terminate the Residency Agreement and commence eviction.”

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

An exit interview was conducted, and a copy of this report was provided to the Executive Director, whose signature on this form confirm receipt of these documents.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 10/10/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022

LIC9099 (FAS) - (06/04)

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