<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198204494
Report Date: 11/03/2021
Date Signed: 11/03/2021 07:18:24 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/25/2021 and conducted by Evaluator Stephanie Cifuentes
COMPLAINT CONTROL NUMBER: 11-AS-20211025121323
FACILITY NAME:ATRIA PARK OF PACIFIC PALISADESFACILITY NUMBER:
198204494
ADMINISTRATOR:BRIAN LARIOSFACILITY TYPE:
740
ADDRESS:15441 W SUNSET BLVDTELEPHONE:
(310) 573-9545
CITY:PACIFIC PALISADESSTATE: CAZIP CODE:
90272
CAPACITY:60CENSUS: 36DATE:
11/03/2021
UNANNOUNCEDTIME BEGAN:
10:23 AM
MET WITH:Adrienne Craig Aziz-Executive DirectorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents did not receive medication on a timely basis.
Facility does not have sufficient staff to meet the residents' needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 11/3/2021 Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced initial complaint investigation at the facility listed above. LPA spoke with staff via telephone call prior to entering the facility to conduct risk assessment questionnaire and was informed that facility had no COVID cases nor do any of the clients have symptoms. LPA arrived at facility and was greeted by Executive Director Adrienne Craig Aziz. LPA explained the purposed of the visit was to investigate the allegations listed above and was granted access to the facility.

The investigation consisted of the following: LPA toured facility grounds and interviewed Executive Director Adrienne Craig Aziz, five (5) staff (S1-S5) and five (5) residents (R1-R5). LPA reviewed documents in association with the allegations.

Continued on 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
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 11-AS-20211025121323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: ATRIA PARK OF PACIFIC PALISADES
FACILITY NUMBER: 198204494
VISIT DATE: 11/03/2021
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
Allegation: Residents did not receive medication on a timely basis.

The complainant alleges that on October 24, 2021, at least two residents did not receive their morning meds. On Tuesday October 26, 2021 LPA Cifuentes received a call from Chad MacDonald, where he stated that on October 24, 2021 the morning medtech called out for their shift and although they tried to find a replacement they were unable to do so at the time. An SIR was received by CCLD via email stating that on October 24, 2021, 28 residents did not receive their morning medications. LPA Cifuentes spoke to Executive Director(ED) Adrienne Craig-Aziz, who confirmed that medtech for Sunday October 24, 2021 called out on October 23, 2021 and that she had reached out to her staff and other Atria communities and several staffing agencies to fill the spot, to no avail. ED then attempted to fill in for the medtech but did not arrive in enough time to pass medications to more than three residents. LPA spoke with residents (R1-R5) regarding their medications. Two of the interviews were not credible due to their diagnosis, one resident’s medication is as needed, another resident administers her own medications. Only the last resident was able to answer about their medications and they stated that they had never had any issues with medications. Of the staff questioned, two out of five stated their had been issues with delayed medications.

Allegation: Facility does not have sufficient staff to meet the residents' needs.

The complainant alleges that a number of staff have quit and the facility is understaffed. LPA spoke with Executive Director Adrienne Craig Aziz regarding staffing. Executive Director stated during interview that there have been staffing issues since May 2021. At the time, she requested staff from other sites to fill the positions while she interviewed, but that by the time that ended, they had been unable to fill as many positions as they needed. Ms. Craig Aziz convinced Atria to allow her to use a staffing agency and they have five agencies they use to fill callouts. All of the facility staff is participating in filling in where there is a need, for instance today, one of the wait staff called out. An agency was contacted to fill the spot, but could not do so, so the cook assisted in serving the residents. Per Ms. Graig Aziz, she had three caregivers in memory care, two in assisted living, and a medtech for both sections. Sometimes these will be two caregivers in memory care, but if it drops to one, all of the facility staff jump in to help. Having three staff in memory care is new, they had two before. LPA interviewed resident, and two stated they did not feel the facility was short staffed, while the other three were not sure. Of the staff interviewed, four out of five stated the facility was short staffed.

Continued on 9099-C

SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20211025121323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: ATRIA PARK OF PACIFIC PALISADES
FACILITY NUMBER: 198204494
VISIT DATE: 11/03/2021
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
Based on information gathered, the department did find sufficient evidence to support allegation " Residents did not receive medication on a timely basis,” “Facility does not have sufficient staff to meet the residents' needs.”

Based on interviews conducted and records reviewed the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.



An exit interview was conducted and a copy of the LIC 9099 and appeal rights forms were provided to Executive Director Adrienne Craig Aziz.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20211025121323
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: ATRIA PARK OF PACIFIC PALISADES
FACILITY NUMBER: 198204494
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/04/2021
Section Cited
CCR
87464(f)(4)
1
2
3
4
5
6
7
Basic Services
Personal assistance and care as needed by the resident...such as dressing, eating, bathing and assistance with taking prescribed medications, as specified in Section 87608, Postural Supports.
This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Licensee will provide licensing with confirmation of completed medtech courses for staff via fax by 11/4/2021
POC cleared on day of visit,
8
9
10
11
12
13
14
Based on records review and interviews, LPA CIfuentes confimed that on October 24, 2021 residents were not assited with taking medications as prescribed. This posses an immediate health and safety issue for residents in care.
8
9
10
11
12
13
14
Type B
11/17/2021
Section Cited
CCR
87411(a)
1
2
3
4
5
6
7
Personnel Requirements - General
Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs...
This requirement was not met as evidenced by
1
2
3
4
5
6
7
Licensee will provide plan to LPA to insure sufficient staff are available for each shift to cover residents needs. Will submit to CCL via fax by POC due date.
POC cleared on day of visit
8
9
10
11
12
13
14
Based on records review and interviews, LPA CIfuentes confimed that on October 24, 2021 facility did not have a medtech on staff. This posses a potential health and safety issue for residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie CifuentesTELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:

DATE: 11/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4