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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800366
Report Date: 02/28/2023
Date Signed: 02/28/2023 01:47:43 PM


Document Has Been Signed on 02/28/2023 01:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:ATRIA HILLCRESTFACILITY NUMBER:
565800366
ADMINISTRATOR:ADAM SYNCHEFFFACILITY TYPE:
740
ADDRESS:405 HODENCAMP RDTELEPHONE:
(805) 373-0606
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:207CENSUS: 98DATE:
02/28/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Adam SyncheffTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Case Management – Incident visit at 1:05pm. The purpose of this visit is to conclude an investigation regarding an incident that occurred on 08/24/2022. Upon arrival, the LPA met with Executive Director (ED), Adam Syncheff and explained the reason for the visit. Entrance interview.

On 08/30/2022, the Department received a SOC 341 from the facility self-reporting incident that had occurred on 08/24/2022, at approximately 7pm which stated Staff #1 (S1) reported that Resident #1 (R1) had kicked S1 on their right rib and right hand. On the same day, when approached by management about incident, R1 admitted to ‘pushing’ S1 with their right foot. However, several days later, R1 stated S1 balled up their fist and punched R1 in the right calf area on their leg. After a body inspection, R1 did not have any bruising to the specific area R1 was pointing to.

During the initial visit on 09/06/2022, the LPA conducted a plant tour to ensure there are no immediate health and safety concerns and interviewed the Administrator and R1 between 1:15pm and 2:30 pm. At 1:45 pm., LPA conducted a resident file review and obtained copies of pertinent documents. On 02/08/2023, the LPA conducted a telephonic interview with S1 at 10:05am.

Interviews conducted revealed other residents S1 assisted around the same time as R1 did not mention hearing about the incident mentioned. Residents stated staff are nice and reported having no concerns with either the staff or facility. Furthermore, S1 denied taking any part in physical abuse against R1 or any other residents at the facility. Although the facility did not determine if S1 was at fault, S1 was let go by the facility in order to avoid any problems arising in the future with R1’s family. Based on this review, no further follow up is required at this time.

Exit interview conducted. No deficiencies cited at this time. A copy of the report was issued to ED.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:
DATE: 02/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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