565800366-3-27-2025-29-AS-KBUY-DF7TJ3-20250328144540

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565800366
Report Date: 03/27/2025
Date Signed: 03/27/2025 04:51:31 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/15/2024 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20240515135218

FACILITY NAME:	ATRIA HILLCREST		FACILITY NUMBER:	565800366
ADMINISTRATOR:	ADAM SYNCHEFF		FACILITY TYPE:	740
ADDRESS:	405 HODENCAMP RD		TELEPHONE:	(805) 373-0606
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	207	CENSUS: 122	DATE:	03/27/2025
		UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:	Gudalupe Ambriz, Community Business Director		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Licensee did not issue accurate refund
Staff did not provide care services agreed upon

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian met with Gudalupe Ambriz to issue final findings on the allegations above.

During the investigation, Licensing Program Analyst (LPA) Zabel Chochian conducted an initial complaint visit to the facility above on 5/21/24. LPA Chochian met with the Executive Director, Remon Pagels and explained the reason for the visit. During the visit LPA Chochian interviewed eight residents and two visitors from 12:45pm to 4:15pm, and collected relevant documents. LPA Erika Miller conducted additional review of documents, and interviewed Resident 1 (R1’s) representative via phone and email.

Allegation: Facility failed to issue an accurate refund. It was alleged that R1 was charged a New Resident Service Fee of $2,895.00, which did not include monthly rent. RP alleges that a portion of the rent was refunded, but the New Resident Service Fee has not been addressed.
(Continue to LIC 9099c)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

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 29-AS-20240515135218

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ATRIA HILLCREST	FACILITY NUMBER: 565800366
	VISIT DATE: 03/27/2025

NARRATIVE

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LPA Miller reviewed the Admission Agreement executed on 11/9/23. Section 7, states in part, “We will refund to you 80% of the amount (“the Excess”) of the New Resident Services Fee that exceeds $500.00 and we will retain $500.00 plus 20% of the Excess if (A) we have conducted a preadmission appraisal of your condition and you do not move into the Community, or (B) you move into the Community and stay for less than one month.” R1 had a preadmission appraisal and stayed for less than one month. The facility retained only $500.00 of the New Resident Services Fee and did not hold the additional 20% as stipulated in the agreement. A review of the facility financial statements reflect that an accurate refund was issued to R1 and calculated as follows: 80% of $2,895.00 Community Fees = $2,316.00. less $500.00, as outlined in the admission agreement, being $1,816.00. The facility further deducted 1) $309.47 Pro-rated December rent 2) $120.38 Late Fee 3) $350.14 for December Level 5 Care, and 4) $57.21 December Med Lev 1 Care. ($1,816.00 - $309.60 - $120.38 - 350.14 - 57.21 = $978.80, being the balance refunded to R1.

LPA Erika Miller interviewed R1’s representative on 1/7/2025, and R1’s representative indicated they did not have an issue with the refund that was provided. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

Allegation: Staff did not provide care services agreed upon. It was alleged that staff did not provide care services as agreed upon in the admission agreement, as the facility did not provide two-person transfer assistance to R1. LPA reviewed Physician’s Report dated 11/14/23, which states R1 is ambulatory, but needs assistance in self-care. LPA reviewed 11/20/23 Functional Needs Assessment, which states R1 is non-ambulatory and uses a walker and wheelchair. Based on the results of the assessment, it was determined that R1 required Level 5 Care, providing up to 17.5 hours of care per week and Med Level 1 Care, that provided for up to two medication passes per day. Facility classified R1’s fall risk as a Stand-By/Remind level of assistance. R1 required limited assistance in bathing/showering, and dressing. R1 also required minimal level of assistance in transfers and escorting. No documents in R1’s file indicate they required two-person transfer assistance.

Interview with R1’s representative revealed after R1 moved in, they were informed the facility is not “licensed” to provide a two-person transfer. R1’s representative stated R1 was very weak when they first moved in from the hospital and needed a two-person assist for several days. R1’s representative stated staff “dropped” R1 on the floor three separate times during a wheelchair to bed transfer, but only reported one fall.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20240515135218

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ATRIA HILLCREST	FACILITY NUMBER: 565800366
	VISIT DATE: 03/27/2025

NARRATIVE

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LPA reviewed files for Unusual Incident Reports on R1 and found no incidents reported during R1’s stay at the facility. Staff confirmed that they were unaware of any falls R1 sustained while at the facility. There was insufficient evidence to support that facility was unable to or failed to provide care as stipulated in the Admission Agreement. The facility is not required to have a specialized license to perform a 2-person assist.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview conducted, and a copy of this report issued.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 03/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025

LIC9099 (FAS) - (06/04)

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