565800366-5-2-2024-29-AS-KLOZ-D5KPG7-20240524111750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565800366
Report Date: 05/02/2024
Date Signed: 05/02/2024 04:22:15 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
11/06/2023 and conducted by Evaluator Esther Cortez

COMPLAINT CONTROL NUMBER: 29-AS-20231106122246

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: 113	DATE:	05/02/2024
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Remon Pagels-Executive Director		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not prevent resident's room from having plubming issues

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Esther Cortez conducted a subsequent complaint unannounced visit to investigate the allegation listed above. The LPA met with Executive Director (ED) Remon Pagels and explained the reason for the visit.

On 11/08/2023, LPA Campos conducted an initial 10-day complaint and met with Memory Care Director,Cassandra Sadowsky. During the visit, LPA Campos interviewed staff at 11:42 a.m. and 11:50 a.m. and collected pertinent documents relevant to the investigation. On 11/28/2023 LPA interviewed one (1) resident. During today's visit, between 10:50 a.m. and 1:00 p.m. the LPA Cortez toured the facility with the ED, interviewed one (1) staff and reviewed interviews and documents collected during the initial 10-Day Visit.

Report will continue on LIC9099C.

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: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

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-20231106122246

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: 05/02/2024

NARRATIVE

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On the allegation that Staff did not prevent resident's room from having plumbing issues, the reporting parties concern is that Resident#1’s (R1’s) room had plumbing issues three (3) times in six (6) months during 2023. To investigate the allegation, the LPA reviewed interviews conducted and documents collected during the initial 10-day visit and conducted interviews. Interviews and documents revealed that the facility did have plumbing issues in 2023, however they had services done to fix the issues and moved R1 to a new unit. Based on the documents review, the above allegation 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: 05/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/02/2024

LIC9099 (FAS) - (06/04)

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