197608685-3-26-2022-31-AS-NMAN-CQJVL5-20230403163123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 03/26/2022
Date Signed: 03/26/2022 02:52:09 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
05/10/2021 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20210510084331

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: 100	DATE:	03/26/2022
		UNANNOUNCED	TIME BEGAN:	08:59 AM
MET WITH:	Venca Avivi - Resident Care Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility is malodorous

Residents room was dirty

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit to this facility to investigate the above allegations. LPA met with Resident Care Director Venca Avivi and informed the purpose of the visit.

LPA conducted physical plant tour at 10:00 AM, requested facility records relevant to the investigation at 11:00 AM and conducted interview with staff and residents between 11:00 AM to 2:00 PM.

Regarding the allegation that the facility is malorodorous, it was alleged that the hallway of the Life Guidance (Memory Care) Unit of the facility reeked of urine. LPA toured all three (3) floors of the Memory Care unit and did not observe any stink and/or bad smell along the hallways and common rooms of the building.

(continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2022

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-20210510084331

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: 03/26/2022

NARRATIVE

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(continued from LIC 9099)

Regarding the allegation that the residents' room was dirty, it was alleged that the room was filthy and had sticky floors and dusty. During today's visit at around 11:00 AM, LPA inspected five (5) random rooms on the first floor, six (6) random rooms on the second floor and nine (9) random rooms on the third floor of the Memory Care building and did not observe any filth, dust or sticky floors on all of the rooms inspected. LPA Valenzuela's physical plant tour conducted on 05/11/21 at 11:15 AM, where in she inspected a total of twenty one (21) random rooms on all floor, also revealed that the facility was clean and in good condition.

Based on the information gathered during this and prior visit, the allegations are deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2022

LIC9099 (FAS) - (06/04)

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