197608685-9-19-2024-31-AS-TAGD-DABP5P-20241023110103

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 09/19/2024
Date Signed: 09/19/2024 02:55:06 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
06/06/2023 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230606104724

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: 132	DATE:	09/19/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	April Princesa		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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1. Resident sustained multiple falls while in care
2. Staff failed to provide resident's authorized representative with incident reports

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tuesday Cabiness met with Executive Director April Princesa, Venca Avivi, Residential Services Director, and Michelle Lagoy, Life Guidance Director. Everyone was notified the reason of the visit, which was to deliver the final findings of the allegations mentioned above.

Allegation # 1: It was alleged resident sustained multiple falls while in care. During the initial investigation, on June 06/07/2023, from 1130am to 2pm, LPA conducted interviews and obtained resident records, as well reviewed facility documents. During today’s visit, from 930am to 230pm, LPA conducted additional interviews and re-reviewed documents. From the information obtained, the initial assessment revealed resident # 1 (R1) did not have any falls for over a year. (R1) was admitted to the facility in January 2023, and in March 2023, there was a change in condition with (R1’s) health and mobility. (R1) began using a wheelchair, which caused (R1) to fall. The facility re-assessed (R1) and implemented changes. Although, it was documented (R1) had several falls, it was due to (R1’s) change in mobility. LPA interviewed (R1’s) family, who reported the facility did the best they could with (R1) due to change of condition, and there was no neglect from the facility.

Unsubstantiated

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: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

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-20230606104724

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: 09/19/2024

NARRATIVE

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Therefore, based on documentation and interviews, the allegation is Unsubstantiated at this time.

Allegation # 2: It was alleged staff failed to provide resident's authorized representative with incident reports. During the initial investigation, on June 06/07/2023, from 1130am to 2pm, LPA conducted interviews and obtained resident records, as well reviewed facility documents. During today’s visit, from 930am to 230pm, LPA conducted additional interviews and re-reviewed documents. It was reported to LPA by the family, that they requested incident reports of (R1) falling at the facility. LPA interviewed staff, who denied there was a request of any documentation for (R1). It was revealed to LPA, that the former Life Guidance Director was no longer working at the facility, and the request could have been directed to her. The family could not specifically identify who they requested the documents to. Therefore, based on interviews, LPA does not have enough evidence to prove the allegation, and it’s Unsubstantiated at this time.

Exit interview and copy of report provided.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024

LIC9099 (FAS) - (06/04)

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