306000372-6-24-2022-22-AS-AORZ-CFUPK4-20220629112228

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000372
Report Date: 06/22/2022
Date Signed: 06/24/2022 10:53:04 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/25/2022 and conducted by Evaluator Kimberly Lyman

COMPLAINT CONTROL NUMBER: 22-AS-20220525143128

FACILITY NAME:	ATRIA DEL SOL		FACILITY NUMBER:	306000372
ADMINISTRATOR:	GOODWIN, JEREMIAH		FACILITY TYPE:	740
ADDRESS:	23792 MARGUERITE PKWY		TELEPHONE:	(949) 458-1176
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92692
CAPACITY:	120	CENSUS: 84	DATE:	06/22/2022
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Jeremiah Goodwin		TIME COMPLETED:	11:08 AM

ALLEGATION(S):

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Facility illegally evicted resident.
Facility did not ensure resident received an assessment.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. Administrator Jeremiah Goodwin was present.
During the course of the investigation, LPA toured the parking lot, interviewed staff and witnesses as well as reviewed and obtained pertinent documentation such as physician report and facility notes. Regarding the allegations that facility did not ensure resident received an assessment and facility illegally evicted resident, the investigation revealed the following: On 05/22/2022, Resident 1 (R1) was observed outside the community in the parking lot by facility staff. Resident was redirected back into the facility without out any adverse effects. Facility indicates corporate policy is to require a one on one care companion when there is an elopement while waiting for an urinalysis. Facility states advising family of the need for a urinalysis and care companion. R1's family member took the resident to obtain a urinalysis and moved R1 out of the facility. Administrator states facility did not conduct a re-assessment as the resident moved out of the facility and family was taking the resident to the physician the next day. CONTINUED ON LIC 9099 C DATED 06/24/2022

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022

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 22-AS-20220525143128

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ATRIA DEL SOL	FACILITY NUMBER: 306000372
	VISIT DATE: 06/22/2022

NARRATIVE

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Witnesses state being advised that the resident needed to move out of the facility immediately. Facility Administrator and Resident Services Director deny advising family that the resident needed to move out immediately and were following corporate protocol to provide a care companion while awaiting results from the urinalysis. Per facility, if the urinalysis came back positive, the resident would need a care companion until the resident was back at baseline. If the test was negative, a care companion would be required permanently or R1 could move to memory care. Facility states resident was offered a bed in the memory care unit which family declined. Facility indicates a room was available in the memory care and provided documentation to LPA. Witnesses deny that a room was made available for the resident. Due to conflicting information, LPA is unable to corroborate the allegations. Therefore, the allegations are deemed unsubstantiated, meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted with Administrator and a copy of this report was provided to facility.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly Lyman	TELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:	DATE: 06/24/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2022

LIC9099 (FAS) - (06/04)

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