197608685-10-17-2022-31-AS-RRAZ-CL3NZK-20221111095427

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 10/17/2022
Date Signed: 10/17/2022 03:01:08 PM

Substantiated

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: 103	DATE:	10/17/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Johnny Ortiz		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff billed resident for services not being provided.
Changes in resident’s condition was not discussed with the family and physician.

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility. LPA met with Johnny Ortiz and discussed the reason for the visit.

--- Facility staff billed resident for services not being provided.
--- Changes in resident’s condition was not discussed with the family and physician.
It was alleged that resident #1 (R1) is being billed for care they are not receiving, and that staff reassessed the R1 but did not inform their doctor. To investigate these allegations, on 09/06/2022 at 12:30 PM, LPA interviewed staff, 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). During interviews with staff, they stated they do not charge for services not provided, that R1 was at a Level One (01) with Level One (01) Medication assistance, that R1's spouse requested for a higher level of care by phone and after a reassessment of needs, the level of care was increased to Level Two (02).
(Cont. on LIC9099-C)

Substantiated

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: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

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: 10/17/2022

NARRATIVE

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After subsequent discussions between staff and the responsible party, the Level was changed back to a Level One (01). During interviews with the responsible party, they stated they are at the facility often, the resident is able to manage some of their own medications, staff are not checking on the resident as needed, staff increased the level of care from a Level One (01) to a Level Two (02) because the RP was no longer able to visit as often and that both they and the resident’s physician were not notified of the change from a Level One (01) to a Level Two (02) in writing. Although Level Two (02) services may or may not have been provided, record reviews revealed that the resident’s Responsible Party AND physician were not notified in writing about the change of the resident's needs and/or condition that resulted in a change of the level of care. Therefore, based on record reviews, the allegation is substantiated at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

No health and safety hazards observed during the visit.

Exit interview was conducted and a copy of 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: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

LIC9099 (FAS) - (06/04)

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Citations on this Visit Report are Under Appeal!

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/17/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Under Appeal Type B 10/24/2022 Section Cited CCR 87463(a)(b)	1 2 3 4 5 6 7	87463 Reappraisals (a)…The reappraisals shall document changes in the resident's physical, medical, mental, and social condition…(b) The licensee shall immediately bring any such changes to the attention of the resident's physician and his family or responsible person.	1 2 3 4 5 6 7	The Licensee will review regulation and submit a written letter certifying that, moving forward, they will ensure to follow and adhere to CCR Title 22 87463 Reappraisals; The written letter must be sent to the LPA by the POC due date.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by; Based on record reviews, the family AND physician were not notified in writing of the change in level of care which poses a potential health, safety and personal rights risk to residents in care.	8 9 10 11 12 13 14	Furthermore, the facility will make any necessary adjustments in fees charged and provide a copy of any adjustments to the LPA by the POC due date.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2022

LIC9099 (FAS) - (06/04)

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