197608685-2-2-2022-31-AS-NMAN-CDQ25H-20220421170524

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608685
Report Date: 02/02/2022
Date Signed: 02/02/2022 06:06:19 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:	DATE:	02/02/2022
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Johnny Ortiz		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Staff did not meet resident's hygiene needs
Staff did not provide adequate laundry service for resident
Resident's room is dirty
Staff are not properly dressing resident
Staff did not provide resident with adequate amounts of water

INVESTIGATION FINDINGS:

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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.

--Staff did not meet resident's hygiene needs.
It was reported that Resident #1's (R1) toenails were overgrown, and no one called responsible party to inform. To investigate these allegations, on 01/24/2022 at 10:30am LPA spoke to facility staff and responsible party. Interviews revealed that the facility is not allowed to cut R1's toenails, that the responsible party was made aware of R1's needs and given multiple options, but responsible party failed to act timely resulting in R1's overgrown toenails. During the investigation conducted on 01/24/2022 at 11:00am, LPA randomly selected residents to inspect and all residents appeared to be well groomed.
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 LIC9099-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: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

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 4

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: 02/02/2022

NARRATIVE

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--Staff did not provide adequate laundry service for resident
It was reported that resident’s laundry hadn’t been done in two weeks because the same clothes were in it. To investigate these allegations, on 01/24/2022 at 11:10am LPA spoke to facility staff and residents. Interviews revealed that laundry is done a minimum once per week. During the investigation conducted on 01/24/2022 at 11:30am, randomly selected rooms were inspected by the LPA which included R1’s bedroom. LPA discovered that each resident has a separate laundry basket and none were full and the residents had plenty of clean linen and clothes.
Based on interviews, inspection and observation, there is no relevant information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--Resident's room is dirty.
It was reported that resident’s room is not being dusted and cleaned and that there were dirty diapers mixed with clean clothes. To investigate these allegations, on 01/24/2022 at 11:10am LPA spoke to facility staff including housekeepers. Interviews indicated that the room is being picked up daily as needed, deeply cleaned and dusted once a week. During the investigation conducted on 01/24/2022 at 11:30am, randomly selected rooms were inspected by the LPA which included R1’s bedroom. The floors appeared to be clean and free from hazard. All inspected rooms were neat and clean with minimal dust. All closets and drawers were checked for cleanliness, nothing soiled was found and everything appeared to be well maintained.
Based on interviews, inspection and observation, there is no relevant information to support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.

--Staff are not properly dressing resident
It was reported that R1 was in a robe that did not belong to R1. To investigate these allegations, on 01/24/2022 at 11:10am LPA spoke to facility staff and residents. The residents were all asked if they felt that they were missing any belongings and they all replied, “no”. Interviews revealed that laundry is done a minimum once per week. During the investigation conducted on 01/24/2022 at 11:30am, randomly selected rooms were inspected by the LPA which included R1’s bedroom. LPA discovered that each resident has a separate laundry basket of which none were full, the residents had plenty of clean linen and clothes.
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 LIC9099-C)

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

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC9099 (FAS) - (06/04)

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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: 02/02/2022

NARRATIVE

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--Staff did not provide resident with adequate amounts of water.
It was reported that resident is not been given water. To investigate these allegations, on 01/24/2022 at 11:10am LPA spoke to facility staff and residents. The residents were all asked if they felt that they were getting enough food and water and those that were able to all replied, “yes”. Interviews revealed that staff encourage food and water intake. During the investigation conducted on 01/24/2022 at 11:30am, randomly selected rooms were inspected by the LPA which included R1’s bedroom. LPA discovered that residents had water in their rooms.
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: 02/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2022

LIC9099 (FAS) - (06/04)

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