198204494-2-16-2022-11-AS-MVAO-CDUUPS-20220426154602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204494
Report Date: 02/16/2022
Date Signed: 02/16/2022 12:56:19 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, 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
01/24/2022 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20220124101916

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:	02/16/2022
		UNANNOUNCED	TIME BEGAN:	10:21 AM
MET WITH:	Kirk Brooks		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

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 2/16/2022 Licensing Program Analyst (LPA) Stephanie Cifuentes conducted an unannounced subsequent complaint investigation at the facility listed above. LPA arrived at facility and was greeted by Executive Director Kirk Brooks. LPA explained the purposed of the visit was to deliver findings regarding the allegations listed above and was grated entry.

The investigation consisted of the following:

On 1/26/2022 LPA Cifuentes conducted a tour of facility grounds, reviewed facility files and spoke with administrator regarding allegations. On 2/3/2022 LPA Cifuentes interviewed staff 1-staff 5 (S1-S5) and residents 1-resident 5 (R1-R5). On 2/16/2022 LPA toured a portion of the facility to check the staffing.

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: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

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 2

Control Number 11-AS-20220124101916

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: 02/16/2022

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

INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Facility does not have sufficient staff to meet the residents' needs.
The complainant alleges that there is insufficient staffing due to the staff not knowing their work schedules. LPA Cifuentes spoke to Resident Services Director Tinatin Darchia, who creates the staff schedules. Per Ms. Darchia, schedules are posted on Thursdays by 3:30pm for the following weeks schedule. Ms. Darchia stated that usually there are three staff in memory care, two staff in assisted living, a medtech who works for both floors. Depending on the day, the Life Guidance Director, the Resident Services Coordinator and the Resident Services Director are available and can substitute if needed to assist with resident care. LPA had previously spoke to Vladimir Kaplun, Executive Director at the time, who stated they had some call offs on January 22, 2022 but they got it covered. Per Ms. Darchin, they had three caregivers that day for the AM shift, the medtech who stepped in to assist with care between passing medications, the Resident Resource Coordinator as well as the Memory Care Director and other staff helping as needed with getting food to the separate floors. LPA spoke with residents (R1-R5) regarding the allegation. All five residents stated they believed the facility had enough staff to meet their need. LPA spoke with staff (S1-S5) regarding allegations. Of the staff questioned, 5 out of 5 stated the facility has sufficient staff to meet the resident’s needs.
Based on information gathered, the department did not find sufficient evidence to support allegation the allegation.

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 allegation: "Facility does not have sufficient staff to meet the residents' needs.”,

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.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2