565800366-5-31-2024-29-AS-KLOZ-D5SVHV-20240531162746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565800366
Report Date: 05/31/2024
Date Signed: 05/31/2024 01:24:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
11/07/2022 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20221107143915

FACILITY NAME:	ATRIA HILLCREST		FACILITY NUMBER:	565800366
ADMINISTRATOR:	BRIAN A LARIOS		FACILITY TYPE:	740
ADDRESS:	405 HODENCAMP RD		TELEPHONE:	(805) 373-0606
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91360
CAPACITY:	207	CENSUS: 116	DATE:	05/31/2024
		UNANNOUNCED	TIME BEGAN:	10:10 AM
MET WITH:	Brian Larios - Senior Executive Director		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff did not distribute resident's medication as prescribed
Staff did not ensure that resident was hydrated
Staff did not monitor resident for change in condition
Staff did not meet resident's dietary needs

INVESTIGATION FINDINGS:

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At 10:10 a.m. Licensing Program Analyst (LPA) Esther Cortez conducted an unannounced subsequent complaint inspection regarding the above allegations. The LPA met with Business Director Lupe Ambriz and explained the reason for the visit. Senior Executive Director (ED) Brian Larios arrived shortly thereafter.

On 11/10/2022, LPA Lopez between 12:55 PM and 3:45 PM reviewed facility records, conducted staff and resident interviews, and obtained copies of pertinent records. On 05/02/2024, LPA Cortez between 1:00 PM and 4:25 PM, reviewed interviews conducted, and facility records collected during the initial 10-day complaint visit and conducted staff interviews, and obtained copies of pertinent records. During today’s visit, LPA Cortez conducted, one (1) resident, and three (3) staff interviews, observed lunch and obtained copies of pertinent documents.

Report will continue on LIC9099-C. (2ND PAGE)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

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-20221107143915

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ATRIA HILLCREST	FACILITY NUMBER: 565800366
	VISIT DATE: 05/31/2024

NARRATIVE

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On the allegation Staff did not distribute resident's medication as prescribed it is the reporting parties (RP) concern that in or about August 2022 staff only distributed half of Resident#1 (R1) Covid medication, while R1 was quarantined. RP also reported that R1’s Covid medicine was in R1’s kitchen counter. To investigate the allegation, file review and interviews were conducted. File review revealed that R1 could manage their own medication. Furthermore, file review reflected that R1 had been assessed on 11/25/21 to determine their ability to self-manage medications. R1 was able to tell time/day/month, could explain signs/symptoms which would require PRN medication use, demonstrated ability to correctly verbalize time and routes of all medications, demonstrated ability to document, order medication and could call refills in a timely manner as well as demonstrated the ability to self-administer all medications prescribed by physician. Staff interviewed revealed that R1 was independent and was not receiving care or part of the medication program. Staff also revealed that staff cannot administer medications to residents who are not on the medication program and residents’ family would have to notify the facility if the resident could no longer manage their medication and needed to be placed on the medication program. While residing at the facility, R1 tested positive for Covid in or about August 2022, however staff revealed that they were unaware if the resident was taking their medication since they were independent and not on the medication program.
Based on interview and record review, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that " Staff did not distribute resident's medication as prescribed"and "is deemed UNSUBSTANTIATED at this time.

On the allegations that Staff did not ensure that resident was hydrated, and that Staff did not monitor resident for change in condition it is the reporting parties concern that on 9/1/2022, R1 was observed to be curled up in bed and not feeling well, and afterwards R1’s physician diagnosed R1 with dehydration. To investigate the allegation, interviews and file review was conducted. Staff interviews revealed that R1 tested positive for Covid in or about August of 2022. Staff noted that residents are not being reassessed, when they get COVID, staff checks on them but no actual paper assessment is done. That if there is a significant change in condition then the resident will get sent to the hospital. Staff interviews also revealed that residents are assessed yearly or when there is a change of condition. On 11/10/22 Senior Executive Director (ED) Brian Larios stated that the nurses were responsible for doing the assessments on the residents. ED Larios also noted that before his time, the previous Executive Director spoke with the family regarding concerns with R1 regarding having dementia and they wanted to move up the date for the resident's medical assessment due to their concerns. REPORT WILL CONTINUE ON LIC9099-C (3RD PAGE).

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 29-AS-20221107143915

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ATRIA HILLCREST	FACILITY NUMBER: 565800366
	VISIT DATE: 05/31/2024

NARRATIVE

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Furthermore, file review reflected that on 08/31/22, the facility’s Divisional Nurse spoke with R1’s son regarding R1’s increased confusion and disorganization and discussed possible transition to memory care, however R1’s son did not feel R1 was ready for memory care. File review further revealed that a request was sent to R1’s physician for an updated LIC602 due to change in condition, and additional tasks for status checks and escorts to meals were entered for two weeks. In addition, file review reflected that facility staff was in communication with R1’s physician. On 7/19/22 a “Notification of Incident or Change of Condition” was sent to R1’s physician informing them that R1 had experienced confusion and difficulty with their speech and R1 was taken to the hospital. R1’s physician did not issue any new orders. On 08/29//22 and additional “Notification of Incident or Change of Condition” was sent to facility staff by the Physician regarding concern for dehydration for R1. R1’s physician provided new orders. Lastly, staff interviews revealed that residents are provided water with every meal, however they can only encourage residents to drink water but cannot force residents. It was also revealed that water is provided throughout the facility, as they have water dispensers throughout the community and residents can go to the bistro, and the dining room and get water bottles at any time.
Based on interview and record review, at this time there is insufficient evidence to support the allegations or that a violation occurred, therefore, the allegations that "Staff did not ensure that resident was hydrated, and Staff did not monitor resident for change in condition" are deemed UNSUBSTANTIATED at this time.

On the allegation that Staff did not meet resident's dietary needs, it is the reporting parties concern that on 8/29/2022, staff delivered R1 a meal that contained sausage and a bottle cap in the food. To investigate the allegation, interviews, file review and observations were conducted. Staff and resident interviews revealed that in 2022 R1 tested positive for Covid on 08/16/22 and when residents test positive for Covid staff would deliver meals to the residents in their rooms. It was also revealed that by 08/26/22 R1’s Covid had resolved. Staff interviews revealed that staff are unaware of any staff delivering a meal with sausage and a bottle cap to any resident. Staff revealed that R1’s family made them aware of the meal tray, however it is unknown who placed the meal in front of the resident’s bedroom. Interviews also revealed that if a resident was mistakenly delivered the wrong meal they could call the front desk and request something different.

REPORT WILL CONTINUE ON LIC9099-C (4TH PAGE).

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 29-AS-20221107143915

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ATRIA HILLCREST	FACILITY NUMBER: 565800366
	VISIT DATE: 05/31/2024

NARRATIVE

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Furthermore, file review of the meal attendance report reflected that R1 was accounted for at the dining room during breakfast, lunch, and dinner on 8/29/22, however it is unclear if R1 went down to the dining room or received their food in their room since the facility was still experiencing a Covid outbreak. Facility’s menu obtained by LPA Lopez in 2022 reflected that the facility provided a variety of food options including Vegan and Vegetarian options in 2022. Menu options included vegetarian minestrone, veggie quesadilla served with guacamole and salsa, salads, eggplant parmesan served with garlic bread stick, among other options. Lastly, during today’s visit the LPA observed resident’s eating a variety of foods in the dining room and was able to interview a resident who is Vegan. Interview conducted with the resident revealed that there have always been food options for them during the 10 years that they have lived at the facility.
Based on interview and record review, at this time there is insufficient evidence to support the allegation or that a violation occurred, therefore, the allegation that " Staff did not meet resident's dietary needs." is deemed UNSUBSTANTIATED at this time.

Exit interview was conducted, and a copy of the report was issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2024

LIC9099 (FAS) - (06/04)

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