197608685-9-18-2024-31-AS-TAGD-D9ESV7-20240924141217

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 08/16/2024
Date Signed: 09/18/2024 01:49:25 PM

Unsubstantiated

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
05/24/2023 and conducted by Evaluator Melissa Spaeth

COMPLAINT CONTROL NUMBER: 31-AS-20230524170317

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: 130	DATE:	08/16/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	April Princesa		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff are illegally evicting resident
Staff obtained & billed resident for services not agreed upon
Staff did not provide requested records to resident's authorized representative

INVESTIGATION FINDINGS:

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This is an amended copy of the report previously issued on 8/16/2024 and 5/30/2023. This report supersedes reports previously issued. The findings for this complaint remain the same.

On 8/14/2024 Licensing Program Analyst (LPA) Melissa Spaeth conducted a subsequent complaint investigation at the above facility to address the following allegation(s). LPA Spaeth was met by the Resident Services Director, Venca Avivi who stated the Administrator would be arriving to the facility. LPA was greeted by the Executive Director, April Princesa at 11:20 am. LPA explained the purpose of this visit was to present the findings.

The investigation consisted of the following: On 5/30/2023 LPA Spaeth initiated a complaint investigation for the allegation(s) listed above. LPA Spaeth requested the resident roster and copies of residents’ files. During the visit, LPA received the documentation.
Continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 31-AS-20230524170317

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
	VISIT DATE: 08/16/2024

NARRATIVE

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Regarding the allegation: Staff are illegally evicting resident: it’s being alleged that R1 was given a 30-day notice to pay or quit due to failure to pay their rent since January, 2023.

LPA Spaeth received a copy of the 30-day notice to pay or quit letter issued to R1 on 5/04/2023. The letter clearly stated R1’s account is past due in the amount of $25,833.95, which represents a past due balance for the months of January through May, 2023. LPA Spaeth interviewed R1 on 5/30/2023 at 11:00 am who stated they did not remember receiving an eviction notice and could not remember if they were up to date with their payments. LPA Spaeth interviewed R1 today, 8/16/2024 at 11:00 am who stated they have made all their payments to the facility. LPA Spaeth spoke to the Business Director, Wendy Rose on 8/12/2024 at 4:00 pm who stated R1 has made all their outstanding payments. Based upon interviews and record review, the allegation is unsubstantiated.

Regarding the allegation: Staff obtained & billed a resident for services not agreed upon: it’s being alleged that the facility told R1 they require supervision when leaving the facility and there would be a monthly additional charge. It’s also being alleged R1 was given a letter stating R1 requires this service and there would be an additional monthly charge for the service each month. LPA reviewed R1’s Admissions Agreement. R1 moved into the facility as of July, 2022. The Admissions Agreement states “Assessment of Your Needs which states a rate change will occur when the change in service occurs due to a resident’s need for a service change. Facility will then review the assessment with the resident.” LPA Spaeth reviewed the physician’s report (LIC 605C) which reveals R1 will need assistance when leaving the facility. LPA interviewed the Resident Services Director (S1) who stated they conducted the yearly assessment for R1 and reviewed the assessment with R1 each year. S1 confirmed R1 was aware they needed assistance when leaving the facility and also told R1 the charge would be indicated on their bill as a “private duty personnel” charge. LPA Spaeth spoke to R1 at 11:00 am who stated they were aware they would be charged for staff assistance when they left the facility. LPA Spaeth interviewed R2 – R10 who confirmed they have never been charged for services they have not agreed upon. Based upon record review, staff and residents’ interviews, the allegation is unsubstantiated.

Continued on 9099C

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 31-AS-20230524170317

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
	VISIT DATE: 08/16/2024

NARRATIVE

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Regarding the allegation: Staff did not provide requested records to resident's authorized representative. It’s being alleged that a resident's authorized representative requested copies of the resident’s records and did not receive them. LPA Spaeth was informed the records requested have been received by the requester. Therefore, the allegation is unsubstantiated.

Exit interview conducted and a copy of the report was given.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Melissa Spaeth	TELEPHONE: (818) 421-2278
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2024

LIC9099 (FAS) - (06/04)

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