197608685-2-8-2022-31-AS-NMAN-CDQ25G-20220421170524

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 02/08/2022
Date Signed: 02/08/2022 12:59:21 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
01/21/2022 and conducted by Evaluator Abeye Duguma

COMPLAINT CONTROL NUMBER: 31-AS-20220121083121

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: 102	DATE:	02/08/2022
		UNANNOUNCED	TIME BEGAN:	09:52 AM
MET WITH:	Johnny Ortiz		TIME COMPLETED:	12:58 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident is left in room all day
Facility did not provide resident with a 60day notice of rent increase for COVID expenses
Resident's closet door is in disrepair

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analysts (LPA) Abeye Duguma conducted an unannounced subsequent complaint visit to the facility. Upon entry, LPA was screened for COVID 19 and met with Executive Director (ED) Johnny Ortiz.

--Resident is left in room all day.
It was reported that Resident #1's (R1) resident is left in the room all day. To investigate this allegation, on 01/24/2022 at 10:30am LPA spoke to facility staff and residents. During the investigation conducted on 01/24/2022 at 11:00am, LPA randomly selected residents to inspect and a few of the residents were eating in isolation due to a recent COVID-19 outbreak by choice. LPA observed the residents' freewill to move about but were encouraged to social distance and avoid physical contact. Staff stated that they try to encourage R1 to participate in activities and walking but cannot force R1 to do so.
Based on interviews, inspection and observation, there is no relevant information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.
(CONT. on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

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-20220121083121

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ATRIA SANTA CLARITA	FACILITY NUMBER: 197608685
	VISIT DATE: 02/08/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

--Facility did not provide resident with a 60day notice of rent increase for COVID expenses.

It was reported that R1 and responsible party was given a notice three weeks ago for rent increase of $500 for COVID expenses starting February 1, 2022. To investigate this allegation, on 02/02/2022 at 12:00pm LPA spoke to facility staff and requested pertinent documents. Interview and record review revealed that the facility notified R1 and responsible party more than sixty (60) days prior to the increase. The notice was sent October 28, 2021 with an increase in rent /fees effective January 01,2022.

Based on interviews record review, there is no relevant information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--Resident's closet door is in disrepair

It was reported that resident’s closet door is broken and only one side opens. To investigate this allegation, on 01/24/2022 at 10:30am LPA spoke to other parties and it was reported that the wooden closet in R1’s room was off its track. The report was supplemented with images that were captured during the other party’s visit to the facility. During the investigation conducted on 01/24/2022 at 11:00am, LPA randomly selected residents’ rooms to inspect and all closet doors were in working order. On 02/02/2022 at 12:15pm, LPA interviewed staff and it was reported resident failed to report the disrepair and that upon discovery, the maintenance crew was informed, and the closet door was placed back on its track with minimal delay.

Based on interviews, inspection and observation, there is no relevant information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Abeye Duguma	TELEPHONE: (818) 669-6814
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3