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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 01/07/2026
Date Signed: 01/07/2026 01:52:23 PM

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
12/31/2025 and conducted by Evaluator Abeye Duguma
COMPLAINT CONTROL NUMBER: 31-AS-20251231084726
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: 119DATE:
01/07/2026
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Venca AviviTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not follow proper rate increase procedures with resident in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to the facility, met with Venca Avivi, and explained the reason for the visit.

--- Staff did not follow proper rate increase procedures with resident in care

It was alleged that Resident #1 (R1) received a monthly rate increase notice on 12/24 without a proper assessment. To investigate the allegation, on 01/07/2026/ LPA requested documents at around 11:00a.m. and interviewed one staff from 12:00p.m. – 12:30p.m. A review of R1’s Medical Assessment dated 10/18/2025 states R1 is able to bathe self with proper devices, e.g. handrail, chair and shower wand. The reassessment dated 12/09/2025 state R1 requires assistance twice a week with preparing all bathing supplies, escorting in and out of the shower/tub, washing and drying body while maintaining dignity.

(CONT on LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026
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-20251231084726
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: 01/07/2026
NARRATIVE
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A review of the Admissions Agreement states , “…we will reassess your needs to determine whether your condition has changed, work with you to update your service plan, if necessary, and review it with you”. During interviews, staff stated facility will meet with R1 or their responsible party on 01/08/2026 to discuss the details and changes in the level of care and the increased fees associated with such changes.

Based on interviews and record review, there is enough information to verify the allegation, therefore, the allegation is SUBSTANTIATED at this time.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D):

No other health and safety hazards noted during the visit.

Exit interview conducted and a copy of the report was issued.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 31-AS-20251231084726
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: 01/07/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
01/09/2026
Section Cited
CCR
87468.1(a)(8)
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(a)Residents in all residential care facilities for the elderly shall have all of the following personal rights: (8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This
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Licensee will meet with R1 or their responsible party to discuss the recent changes. Licensee will review regulation and submit a written letter stating they have conducted their meeting and reviewed regulations.
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requirement is not met as evidenced by; Based on interviews and record review, facility did not meet with R1 or RP to discuss the details behind the most recent rate increase which poses a potential health safety and personal rights 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.
SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3