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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 10/30/2025
Date Signed: 10/30/2025 09:56:46 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 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: 123DATE:
10/30/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Venci Avivi & April PrincessaTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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Facility staff neglect resulted in resident sustaining a fracture
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness met with Venci Avivi, Resident Service Coordinator and informed her of the purpose of the visit. Executive Director April Princessa, arrived shortly after and was also informed of the visit. LPA delivered the final findings of the complaint investigation.

On January 24, 2025, the Woodland Hills South Adult and Senior Care Regional Office received a complaint for the following allegation: “Facility staff neglect resulted in resident sustaining a fracture”. The same day, the complaint was referred to the Community Care Licensing Division’s (CCLD’s) Investigations Branch (IB), and assigned to Investigator, Sonia Torre. The following investigation and fact finding was determined:

The initial investigation visit was conducted by LPA Tuesday Cabiness on 02/24/2025 from 1245pm to 230pm to obtain resident and facility documents: special incident reports (SIRs), resident agreement, move-in information, fire department records, physician report and resident assessment model. Between 01/25/2025 and 04/26/2025 IB Investigator Torre conducted interviews with residents, staff, witnesses, and reviewed, resident records,
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ATRIA SANTA CLARITA
FACILITY NUMBER: 197608685
VISIT DATE: 10/30/2025
NARRATIVE
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SIRs, and medical records involving resident #1 (R1).

“Facility staff neglect resulted in resident sustaining a fracture”. It was alleged that between 09/15/24 and 12/06/24 residents #1 (R1) had six (06) reported falls. The last fall incident occurred on 12/06/25 resulting in sustaining a broken femur. According to the investigation conducted by IB investigator Torre, and the review of the 911 audio call, it was revealed that the resident was very heavy, did not want to be changed in bed and was unable to “hold themselves.”

According to the interview by the Residential Services Director (RSD), who confirmed the facility planned to reassess R1 in September 2024 due to the falls to determine the next appropriate level of care but failed to do so because the facility was unable to contact the responsible party. The facility preferred to first meet with R1’s responsible party before implementing a new care plan. The RSD stated two person assists for transfers were utilized at the discretion of staff and only offered on a temporary basis because it was against the facility’s policy. The interviews with staff revealed R1’s health continued to decline. R1 was considered a fall risk, and no new corrective action and/or care plan was implemented to address the recurrent falls.
The review of the facility records including internal incident reports revealed the last (annual) assessment completed on R1 was on 08/13/2024 which resulted in an increase in care level. Subsequently, after the assessment, R1 sustained multiple falls (09/15/2024, 09/20/2024, 09/23/2024 10/01/2024, 11/13/2024 and 12/06/2024) where R1 legs reportedly continued to give out while being transferred by a single staff.
Therefore, based on interviews and record review, the allegation of “facility staff neglect resulted in resident sustaining a fracture, while in care of the facility”, is Substantiated. This is a health and safety risk to residents in care.

A $500 immediate civil penalty is assessed today for a violation posing immediate danger to the resident’s health and safety. The licensee/administrator was informed that additional civil penalties might be assessed based on Health and Safety Code 1569.49(f), or 1548(e) or (f), 1568.0822(f).

Exit interview, appeal rights, civil penalty, and copy of report provided to Administrator.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 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.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ATRIA SANTA CLARITA
FACILITY NUMBER: 197608685
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/30/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/31/2025
Section Cited
CCR
87468.2(a)(4)
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Additional Personal Rights of Residents in Privately Operated Facilities: (a)...residents in privately operated residential care facilities for the elderly shall have …the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in
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Executive Director will discuss with corporate and legal team in regards to training for staff and the Resident Services Director. The ED will notify LPA by the COB 10/31/2025, the exact specifics of training, and date and time.If further time is needed to accomplish the POC, the ED will remain in communication
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numbers qualifications, and competency ...This requirement was not met, evidenced by, based on the investigator Torre, R1 was considered a fall risk, and no new corrective action and/or care plan was implemented to address the recurrent falls.This a health and safety risk to residents in care.
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with LPA. Submit training documents of the topics, and staff attending.
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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.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Tuesday Cabiness
LICENSING EVALUATOR SIGNATURE:

DATE: 10/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2025
LIC9099 (FAS) - (06/04)
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