197608685-1-23-2024-31-AS-MVAO-D27T7H-20240206132846

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 01/23/2024
Date Signed: 01/23/2024 12:26:32 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
01/22/2024 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20240122091521

FACILITY NAME:	ATRIA SANTA CLARITA		FACILITY NUMBER:	197608685
ADMINISTRATOR:	APRIL PRINCESA		FACILITY TYPE:	740
ADDRESS:	24431 LYONS AVE		TELEPHONE:	(661) 254-9933
CITY:	SANTA CLARITA	STATE: CA	ZIP CODE:	91321
CAPACITY:	160	CENSUS: 124	DATE:	01/23/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	April Princesa		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Residents safety pendents are inoperable

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced complaint visit and met with the Executive Director (ED) April Princesa, who was informed the reason of the visit. The following was determined:
It was alleged the resident's safety pendents were not operable. During today's visit, from 945am to 1230pm, LPA conducted a physical plant inspection, interviewed residents and staff, and reviewed facility documents. On 01/19/2024, the ED and facility staff were notified by residents that there pendants were not working. The alarm was tested, and it was determined by the IT Support team the computer system had crashed, and needed to be replaced. The ED reported to LPA, it took (4) days to repair, and on 01/22/2024, the system was operating properly. LPA verified the system was operating, by having staff do a test check. Residents were notified the system was not working and when it was repaired. LPA confirmed that during interviews with residents. Also LPA obtained facility document that was provided to all residents. LPA also reviewed incident reports; there were no health and safety concerns. Therefore, the allegation is Substantiated and POC was cleared during visit.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

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-20240122091521

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ATRIA SANTA CLARITA	FACILITY NUMBER: 197608685
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/23/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/23/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met	1 2 3 4 5 6 7	POC cleared -- documentation was provided the computer system was replaced.
	8 9 10 11 12 13 14	evidenced by, based on today's interviews, it was reported the resident's pendents were not working for (4) days. This is a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 01/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/23/2024

LIC9099 (FAS) - (06/04)

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