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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565800366
Report Date: 05/22/2025
Date Signed: 05/22/2025 12:03:47 PM

Substantiated


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
11/06/2024 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20241106103236
FACILITY NAME:ATRIA HILLCRESTFACILITY NUMBER:
565800366
ADMINISTRATOR:REMON PAGELSFACILITY TYPE:
740
ADDRESS:405 HODENCAMP RDTELEPHONE:
(805) 373-0606
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:207CENSUS: 125DATE:
05/22/2025
UNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Remon PagelsTIME COMPLETED:
12:10 PM
ALLEGATION(S):
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Staff are not assisting residents with feeding
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation for the allegation listed above. LPA arrived at the facility at 09:28AM and met with Executive Director (ED) Remon Pagels. Entrance interview conducted.

During an unrelated visit conducted on 04/24/2025, LPA interviewed ED throughout the visit and reviewed and obtained copies of additional relevant documents. During an initial complaint visit conducted on 11/13/2024, LPA interviewed ED at 09:55AM, reviewed resident records beginning at 10:32AM, toured the facility at 11:38AM, interviewed resident's family member at 11:44AM, and conducted staff interviews from 11:59AM to 1:10PM. LPA also obtained copies of pertinent documents. Throughout the course of the investigation, LPA reviewed all documents obtained and telephonically interviewed other relevant parties. The following was then determined:

Report Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
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 4
Control Number 29-AS-20241106103236
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: 05/22/2025
NARRATIVE
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It was alleged that staff are prohibited from assisting residents with feeding, including Resident #1 (R1) and Resident #2 (R2) who reside in the facility’s memory care unit and are receiving hospice care services. During the initial complaint visit, LPA interviewed multiple staff, Administrator and Corporate office representative. All employees interviewed indicated this facility does not assist residents with feeding. ED indicated all families are aware of the Atria policy and the facility’s Admission Agreement indicates Atria does not provide these services. Review of Acceptance and Retention criteria revealed that residents “must have the ability to feed him or herself.” LPA reviewed the Admission Agreement signed by R1’s representative, which does include the attachment referenced, however, the Admission Agreement that was submitted to Community Care Licensing Division (CCLD) upon licensure does not include this Attachment nor any policy indicating residents must be able to feed themselves. LPA confirmed with ED that the facility’s Admission Agreement and current related policies have not been sent to nor approved by CCLD. Interview with ED and corporate representative revealed that the facility is not staffed to assist with feeding residents and residents in the facility need to be able to feed themselves or have a private caregiver or family member to assist with resident’s feeding. ED reiterated that facility staff do not assist residents with feeding. Corporate representative stated that if a resident declines and requires any of the services Atria does not offer, as outlined in the Acceptance and Retention Criteria (such as puree food, thickened liquids, or feeding assistance) that the facility staff may assist the resident for up to 30 days while an eviction notice is served to the resident. However, interviews conducted during the initial complaint visit revealed that staff have been instructed not to assist with feeding, as it is against policy. None of the care staff interviewed mentioned they are able to assist with feeding temporarily while a resident is relocated. Instead, all care staff interviewed stated they have been instructed that assisting residents with feeding is against policy.

As far as R1, ED stated that R1 passed away under hospice care, but near the end R1 had a private companion to assist in feeding R1. Record review revealed that in a fax dated 09/20/2024, facility staff communicated to R1’s hospice care provider “[R1] needs to be fed by care staff or else [R1] won’t eat.” However, interview revealed care staff are not allowed to assist residents with feeding. In the case of R2, ED stated that R2’s family member is present for 2 (two) meals a day 6 (six) days a week and when R2’s family member isn’t present, R2 will still pick at their food. Interview with R2’s family member revealed that they assume the staff are spoon feeding R2 when the family member is not present at the facility. R2’s family member appeared to be unaware of Atria’s policy related to feeding. Staff did state R2 will sometimes feed

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20241106103236
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: 05/22/2025
NARRATIVE
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themselves if the food is placed in their hand, but staff have been reminded this is not allowed per Atria policy. Review of Atria plan of operation revealed that “the community must provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself…The community must provide this assistance and cannot delegate this care to family members, private duty personnel, outside agencies, etc.,” which is consistent with Title 22 Regulation. Both ED and corporate representative interviews revealed the facility is delegating ADL care such as feeding to private duty aides and family members, contrary to the facility policy. ED also stated that per ED's conversation with corporate, that changes to both the Admission Agreement and facility’s policies related to feeding and care services offered were not submitted to CCLD for approval. Based on interview and record review, the preponderance of evidence standard has been met, therefore, the allegation “staff are not assisting residents with feeding” is deemed SUBSTANTIATED at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiency is cited (refer to LIC9099-D).

Exit interview conducted, appeal rights discussed, and a copy of this report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20241106103236
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/22/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/06/2025
Section Cited
CCR
87208(a)
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87208 (a) The licensee shall have and maintain a current, written definitive plan of operation for the facility...significant changes in the plan of operation which would affect the services to residents shall be submitted to the licensing agency for approval...
This requirement is not met as evidenced by:
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Executive Director agreed to contact corporate to amend and submit the facility's plan of operation and related documents to CCL for approval by POC due date.
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Based on interview and record review, the facility has changed it's policies and Admission Agreement as it relates to care services offered to residents, however no approval was obtained from the Department, which poses a potential health and personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 05/22/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/22/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4