197608685-6-24-2026-31-AS-TAGD-DYETGC-20260930144256

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 06/24/2026
Date Signed: 06/24/2026 01:29:08 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.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
06/23/2026 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20260623112928

FACILITY NAME:	ATRIA SANTA CLARITA		FACILITY NUMBER:	197608685
ADMINISTRATOR:	TRACEY PAULK		FACILITY TYPE:	740
ADDRESS:	24431 LYONS AVE		TELEPHONE:	(661) 254-9933
CITY:	SANTA CLARITA	STATE: CA	ZIP CODE:	91321
CAPACITY:	160	CENSUS: 122	DATE:	06/24/2026
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Tracey Paulk		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff do not prevent resident from verbally abusing other residents.
Staff do not prevent resident from disturbing other residents' sleep.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Abeye Duguma conducted an unannounced initial complaint visit to the facility, met with Tracy Paulk, and explained the reason for the visit.

--- Staff do not prevent resident from verbally abusing other residents.

It was alleged that Resident #1 (R1) is verbally abusive to other residents. To investigate the allegation, on June 24, 2026, LPA requested documents at around 9:30 a.m., interviewed two (02) staff from around 10:00a.m. to 11:30a.m. and twelve (12) residents from around 11:30a.m. to 1:00p.m. A review of documents provided by the facility shows that the incident was reported to the Department. During interviews, all staff stated they are aware of Resident #1’s (R1) change in behavior. Staff explained there was an incident that involved them having to call the Sherriff’s Department where R1 was verbally aggressive with Resident #2 (R2) and emergency services were contacted.
(CONT on LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Troy Agard
LICENSING EVALUATOR NAME: Abeye Duguma
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2026

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-20260623112928

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: 06/24/2026

NARRATIVE

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Staff also contacted a physician for a possible medication adjustment and notified the Department and Responsible Party. During interviews with residents, R1 stated they do not verbally abused R2 or other residents. R2 also stated they are not being verbally abused by R1 or other residents. All other residents stated they are not being verbally abused by residents.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--- Staff do not prevent resident from disturbing other residents’ sleep.

It was alleged that R1 is walking into other residents rooms at around 1:00a.m. to 3:00a.m. and disturbing their sleep for the past one (1) to two (2) weeks. It was also alleged, R1 is barricading the bedroom/unit door leaving R2 in the room for over twelve (12) hours. To investigate the allegation, on June 24, 2026, LPA interviewed two (02) staff from around 10:00a.m. to 11:30a.m. and twelve (12) residents from around 11:30a.m. to 1:00p.m. During interviews, all staff stated they are aware of Resident #1’s (R1) attempting to barricade the door but not aware of R1 going into people’s rooms in the middle of the night. Staff explained that the chairs never interfered with care and supervision and that R2 was checked on every two hours. During interviews with residents, R1 stated they do not go into resident’s rooms in the middle of the night and do not barricade the door. R2 stated they are not aware of anyone entering the room in the middle of the night, does not feel their sleep is disturbed and knows nothing about the door being barricaded. All other residents stated they are not aware of residents entering their room or disturbing their sleep during the middle of the night between 1:00a.m. to 3:00a.m.

Based on interviews, there is not enough information to verify the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

No 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: 06/24/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2026

LIC9099 (FAS) - (06/04)

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