198204494-2-23-2022-11-AS-MVAO-CDUUM5-20220426154145

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198204494
Report Date: 02/23/2022
Date Signed: 02/23/2022 05:08:16 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
02/16/2022 and conducted by Evaluator Stephanie Cifuentes

COMPLAINT CONTROL NUMBER: 11-AS-20220216170056

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: 34	DATE:	02/23/2022
		UNANNOUNCED	TIME BEGAN:	12:12 PM
MET WITH:	Kirk		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Facility did not permit the formation of a resident council

INVESTIGATION FINDINGS:

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On 2/23/2022 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 granted entry.

The investigation consisted of the following:

On 2/23/2022 LPA Cifuentes conducted a tour of facility grounds, reviewed facility files and spoke with Executive Director regarding allegations. On 2/3/2022 LPA Cifuentes interviewed staff 1-staff 4 (S1-S4) and residents 1-resident 4 (R1-R4). LPA requested and received a facility roster, staff roster and other documents pertinent to the investigation.

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: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220216170056

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: 02/23/2022

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:
Allegation: Facility did not permit the formation of a resident council

The complainant alleges that residents’ families had not been made aware of a family council until an email sent out on February 6^th, 2022 by the new Executive director. LPA Cifuentes toured facility ground and found a sign at the front reception desk advertising family council meetings. LPA Cifuentes also saw the minutes from the family council meeting posted on a bulletin board in the hall leading to the dining room. LPA also noted that the activities board shows a date, time and place for the resident council. LPA Cifuentes spoke with Kirk Brooks, Executive Director, who stated that the family council formed right before his arrival and that the resident council is on the facilities activity schedule. LPA reviewed resident records and noted that pages 22 to 25 of the admissions agreement are the statements of resident’s personal rights, and outline both the right of the resident to organize and participate in a resident council, but also the rights of resident’s families to organize and participate in a family council. All the documents reviewed by LPA were signed by the resident’s responsible parties. LPA Cifuentes was given copies of the resident activity schedule for December and January, which both show the date time and place of the resident’s council. LPA spoke with residents (R1-R4) regarding the allegation. All four residents stated they were aware facility had a resident council. LPA spoke with staff (S1-S4) regarding allegations. Of the staff questioned, 4 out of 4 stated the facility has a resident’s council, and all four also stated that the facility currently has a family council as well.

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 did not permit the formation of a resident council”

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 and a copy of this report left with Executive Director Kirk Brooks.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7763
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022

LIC9099 (FAS) - (06/04)

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