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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 08/21/2024
Date Signed: 08/21/2024 02:37:03 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
08/12/2024 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20240812193250
FACILITY NAME:ATRIA SANTA CLARITAFACILITY NUMBER:
197608685
ADMINISTRATOR:APRIL PRINCESAFACILITY TYPE:
740
ADDRESS:24431 LYONS AVETELEPHONE:
(661) 254-9933
CITY:SANTA CLARITASTATE: CAZIP CODE:
91321
CAPACITY:160CENSUS: 135DATE:
08/21/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:April PrincesaTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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1. Staff do not ensure resident's are showered
2. Staff do not provide daily activities for residents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a complaint visit and met with the Executive Director (ED) April Princesa, who was explained the reason of the visit.

Allegation # 1: It was alleged staff do not ensure residents are showered. During today’s visit, from 930am to 245pm, LPA conducted a physical plant inspection, reviewed facility documents and interviewed staff and residents. From the information obtained, residents are showered twice a week, and as needed. Therefore, based on interviews, the allegation is Unsubstantiated at this time.
Allegation # 2: It was alleged staff do not provide daily activities for residents. During today’s visit, from 930am to 245pm, LPA conducted a physical plant inspection, reviewed facility documents and interviewed staff and residents. From the information obtained, the staff follow the activity schedule that is created by facility staff for the assisted living and memory care unit. LPA also observed residents participating in arts and crafts during the visit, and reviewed the activity schedule. Therefore, based on observations and interviews, the allegation is Unsubstantiated at this time. Exit interview and copy of report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
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
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
08/12/2024 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20240812193250

FACILITY NAME:ATRIA SANTA CLARITAFACILITY NUMBER:
197608685
ADMINISTRATOR:APRIL PRINCESAFACILITY TYPE:
740
ADDRESS:24431 LYONS AVETELEPHONE:
(661) 254-9933
CITY:SANTA CLARITASTATE: CAZIP CODE:
91321
CAPACITY:160CENSUS: 135DATE:
08/21/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:April PrincesaTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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9
Resident wandered away from the facility due to lack of care and supervision
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness met with Administrator April Princesa and explained the reason of the visit. The following was determined:

It was alleged resident wandered away from the facility due to lack of care from staff. During today’s visit, from 930am to 245pm, LPA conducted a physical plant inspection, reviewed documents, and interviewed staff. According to the information obtained, staff dis-armed the front door of memory care with the passcode for visitors that were leaving. It is assumed that resident # 1 (R1) wandered out the front door with the visitor who was leaving. Staff was not aware that (R1) was near the front door and accidentally walked out. A family member who was in the parking lot at the facility, saw (R1) and returned (R1) back to memory care. This is an immediate health and safety risk to residents in care. Therefore, based on interviews, the allegation is Substantiated.

Exit interview, citation issued, appeal rights, and copy of report provided
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20240812193250
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: 08/21/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/22/2024
Section Cited
HSC
1569.312(e)
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Every facility required to be licensed under this chapter shall provide at least the following basic services: (e) Monitoring the activities of the residents while they are under the supervision of the facility to ensure
their general health, safety, and well being
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Administrator and Supervisor from the memory care unit, will conduct an in-service training to all staff regarding how to safeguard residents from eloping from memory care. POC cleared during the visit, training was already conducted.
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This requirement is not met as evidenced by: based on interviews during today's visit, (R1) walked out the front door of the memory care unit without staff awrare. This is an immediate health and safety risk to residents in care.
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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: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3