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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 06/26/2025
Date Signed: 06/26/2025 01:04:37 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
01/22/2025 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20250122155506
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: 117DATE:
06/26/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:April Princessa & Venca AviviTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility staff did not follow resident's admission agreement
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit and met with Resident Services Director Venca Avivi and informed her the reason of the visit. Executive Director April Princessa was not present during the initial visit, but came shortly after. The following was determined during today's visit:

It was alleged that facility staff did not follow resident's admission agreement. To investigate the allegation, (LPA) conducted visits on 02/24/2025 and today, between approximately 9:30 a.m. and 2:30 p.m. During today's visit, LPA conducted additional interviews and reviewed facility and resident records. The admission agreement, which was reviewed and signed by R1, did not contain any specific provisions indicating that R1 required two-person assistance. Although it was reported that R1’s family privately compensated the facility for additional care, LPA was not provided with any supporting documentation to verify this arrangement. Multiple requests for such evidence were made but were unsuccessful. LPA reviewed R1’s records, which showed that upon admission, R1 required minimal assistance and was independent.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2025
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-20250122155506
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: 06/26/2025
NARRATIVE
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Over time, however, R1’s health declined, and R1 became a fall risk. Facility staff appropriately documented this decline and implemented preventative measures in collaboration with R1’s medical providers.

Based on the available documentation and lack of corroborating evidence, there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report provided to Executive Director.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 06/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3