198204494-2-3-2022-11-AS-EMAZ-CDMSMT-20220419140024

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204494
Report Date: 02/03/2022
Date Signed: 02/03/2022 05:43:26 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, 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
01/27/2022 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20220127140129

FACILITY NAME:	ATRIA PARK OF PACIFIC PALISADES		FACILITY NUMBER:	198204494
ADMINISTRATOR:	BRIAN LARIOS		FACILITY TYPE:	740
ADDRESS:	15441 W SUNSET BLVD		TELEPHONE:	(310) 573-9545
CITY:	PACIFIC PALISADES	STATE: CA	ZIP CODE:	90272
CAPACITY:	60	CENSUS: 36	DATE:	02/03/2022
		UNANNOUNCED	TIME BEGAN:	10:01 AM
MET WITH:	Stacey Groman		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility is not allowing visitors.
Facility mismanaged resident's medication.
Facility does not communicate with resident's responsible party.

INVESTIGATION FINDINGS:

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On 2/3/2022 Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced initial complaint investigation at the facility listed above. LPA arrived at facility and was greeted by Quality Control Stacey Groman. LPA explained the purposed of the visit was to investigate the allegations listed above and was grated entry.

The investigation consisted of the following:

On 2/3/2022 LPA Cifuentes toured facility grounds, reviewed facility files and interviewed staff 1-staff 5 (S1-S5) and residents 1-resident 5 (R1-R5)

Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

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 11-AS-20220127140129

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: 02/03/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Facility is not allowing visitors.

The complainant alleges that they were not allowed in to the facility to visit family, despite having all of their vaccinations and a negative Covid-19 test. LPA spoke to facility Nurse Tinatin Darchia, who stated facility went into full building quarantine on 1/2/2022 due to the amount of Covid-19 cases in the community. In a letter sent to residents and families it stated that family visits were restricted to drive-up and terrace visits only, with the exception of end of life situations. This lockdown extended to 1/27/2022 and families were allowed to visit indoors starting 1/28/2022. A letter was sent to families informing them of the change in status. LPA spoke with residents (R1-R5) regarding the allegations. Four of the five residents interviewed stated they were allowed to have visitors, outdoors only during the lock-down. LPA spoke with staff (S1-S5) regarding allegations. Of the staff questioned, 5 out of 5 stated the residents were allowed to have outdoors visits during Covid-10 lockdown, and that there was no baring of visitors when the facility was not in lockdown.

Based on information gathered, the department did not find sufficient evidence to support allegation " Facility is not allowing visitors”

Allegation: Facility mismanaged resident's medication.

The complainant alleges that when R1 left the facility to spend time with family, they did not receive sufficient medications for the time period they would be gone. LPA reviewed facility documents and found a medication release form for R1 detailing the medications and the amount provided to the family. A second medication release form was also found, detailing an additional amount of medication that was provided to R1’s family. LPA interviewed residents regarding allegation and of the residents interviewed 4 out of 5 gave them their medications timely and has not given them the wrong medications. Only 2 of the 5 residents interviewed have traveled out of the community for several days and both of the residents stated they had received sufficient medications. Of the staff interviewed, 5 out of 5 stated the facility gave residents their medications timely and had not given them the wrong medications. 3 out of the 5 staff interviewed mentioned the facility having a tracking system for medication release and 2 of those 3 stated the facility gave families the correct medications for their time out of the facility.

Based on information gathered, the department did not find sufficient evidence to support allegation “Facility mismanaged resident's medication.”

Continued on 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20220127140129

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: 02/03/2022

NARRATIVE

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Allegation: Facility does not communicate with resident's responsible party.

The complainant alleges that they got no response when emailing and calling the facility Executive Director. The complainant also alleged that facility staff are not brushing residents’ teeth. LPA received copies of emails/application updates sent to families regarding Covid-19 facility lock down. LPA spoke with residents (R1-R5) regarding the allegations. Of those interviewed 4 out of 5 stated they were not aware of any communication issues between facility and their family. LPA interviewed S1-S5 regarding allegation. 4 out of 5 staff stated that residents families have not mentioned any communication issues.

Based on information gathered, the department did not find sufficient evidence to support allegation " Facility does not communicate with resident's responsible party.”

The Department’s investigation consisted of an inspection of the facility, observation, analysis of facility records and interviews conducted and found no evidence to support the allegations: "Facility is not allowing visitors.”, "Facility mismanaged resident's medication”, “Facility does not communicate with resident's responsible party”,

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted with Stacey Groman Quality Enhancement Director and a hard copy was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

LIC9099 (FAS) - (06/04)

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