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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565800366
Report Date: 04/01/2022
Date Signed: 04/01/2022 01:33:34 PM



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
09/17/2021 and conducted by Evaluator Martha Guzman-Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20210917093825
FACILITY NAME:ATRIA HILLCRESTFACILITY NUMBER:
565800366
ADMINISTRATOR:SARAH DODDFACILITY TYPE:
740
ADDRESS:405 HODENCAMP RDTELEPHONE:
(805) 373-0606
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91360
CAPACITY:207CENSUS: 111DATE:
04/01/2022
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Sarah DoddTIME COMPLETED:
01:35 PM
ALLEGATION(S):
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Facility staff had resident expose himself to staff
Facility staff hit resident
Facility staff did not accord resident privacy
Resident sustained multiple falls while in care
Facility staff left resident on the floor for an extended period of time
Facility staff did not respond to resident's call button in a timely manner
Facility staff did not assist resident with medical appointments
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Martha Guzman Chavez conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegations. The initial visit was conducted on 9/20/2021 and a subsequent visit was conducted on 10/01/2021, by LPA’s M. Guzman Chavez and K. Lopez. On today’s visit, LPA Guzman Chavez met with Executive Director (ED), Sarah Dodd. Entrance interview conducted.

During the initial visit on 9/20/2021, between 10:07 a.m. and 3:07 p.m., the LPA’s Guzman Chavez and Lopez conducted interviews with the ED, five (5) facility staff, and four (4) residents. The LPA’s also conducted a record review at 10:47 a.m. and reviewed and obtained copies of census, staff schedule, resident records, staff records, and other pertinent documents. On 10/01/2021, between 1:52 PM and 2:47 pm, LPA’s Guzman Chavez and Lopez conducted interviews with three (3) residents and obtained copies of census, staff schedule, resident records, and other pertinent documents relevant to the investigation. LPA Guzman Chavez also interviewed Med-Tech, Elijah Soltan on 3/24/2022 at 2:25 p.m.
...Continued on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Guzman-ChavezTELEPHONE: (818) 596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2022
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-20210917093825
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: 04/01/2022
NARRATIVE
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...Continued from LIC 9099...

It was alleged that facility staff had resident expose himself to staff. It was reported Resident #1 (R1) has a small tattoo on R1s body and staff would come and ask to see it. Per staff interviews, the staff are aware of R1’s tattoos. However, they denied any allegations of having R1 expose themselves to them at any time. They added, the only reason they knew about the tattoo is because they have all assisted R1 with baths. Similarly, interviews with staff revealed R1 would bring up their tattoo during their conversations. Furthermore, interviews with residents revealed R1 had a tendency to go off on a tangent. Based on interviews, the Department does not have sufficient evidence to support the allegation of “Facility staff had resident expose himself to staff”. Therefore, the allegation is deemed Unsubstantiated at this time.

It was also alleged that facility staff hit resident. Per Resident Notes, it was revealed that R1 had reported different stories to several staff members when asked about the bruising on their left eye. Staff interviews revealed that R1 had frequent falls and therefore was assessed to be a high-risk fall. Additionally, per Resident Notes, on 3/19/2020, the Resident Services Director (RSD) added that when R1 was asked what happened, they stated, ‘they fell and hit their head on the fridge’. Later on, R1 stated to the paramedics, “they got dizzy after taking their medicine fell and hit their head”. R1 refused to be transported to the hospital for any further treatment. However, when R1’s spouse came back from a doctor’s appointment, R1 reported to them that the med-tech had hit them. Because of the given statement, the Ventura County Sheriff’s Department was called to the facility to investigate. Per police report dated 3/19/2020, Staff #1 (S1) had walked to R1’s room to deliver medication and when R1 opened the door, S1 noticed the injury on R1’s left eye and asked about it. S1 and R1 ‘joked’ about the injury briefly before R1 was escorted to the dining room by another staff. Because of the conflicting statements given to the Sherriff, they were ‘unable to establish that a crime had occurred’. Furthermore, due to the severity of the allegation, the Ventura County Sheriff’s Department was called out to the facility again on 9/15/2021. Per police report dated 9/15/2021, when asked about the allegations R1 stated the conversation was in a joking manner and then proceeded to report that they felt comfortable at the facility and did not believe that they were being abused in any way by any member of the staff at the facility. Based on the information and documentation obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “Facility staff hit resident”. Therefore, the allegation is deemed Unsubstantiated at this time.

...Continued on LIC 9099C...

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Guzman-ChavezTELEPHONE: (818) 596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20210917093825
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: 04/01/2022
NARRATIVE
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...Continued from LIC 9099C...

It was further alleged that resident sustained multiple falls while in care. Records review revealed R1 was a high fall risk as they had had several falls in the previous years. The resident’s notes displayed numerous times when staff would ask R1 to be more careful and walk slower to keep safe. Furthermore, R1’s falls significantly reduced as they followed orders when asked not to move too fast causing them to lose their balance. Per Resident Functional Needs Assessment dated 7/07/2021, it states R1 requires extensive assistance three (3) times per day. R1 stated they stumble often but have not had any falls recently. Interviews with staff revealed that they are familiar with all residents in the facility that have a high-risk fall. Staff stated they do routine checks on R1 at least three (3) times during their shifts. Additionally, they reported R1 has had no falls recently and recall the last fall to be sometime in 2020. Furthermore, staff added that they remind R1 to use their walker or wheelchair for support. Based on interviews and record review, the Department does not have sufficient evidence to support the allegation of “resident sustained multiple falls while in care”. Therefore, the allegation is deemed Unsubstantiated at this time.

It was further alleged that facility staff left R1 on the floor for an extended period of time and that staff did not respond to the resident’s call button in a timely manner. Information gathered during the course of the investigation revealed that residents feel that staff respond in a timely manner when they request for assistance. When residents use their pendants to request for help, the staff come to check on them relatively quick. Additionally, a resident stated that when they had a fall recently, ‘they responded quickly, maybe two (2) or three (3) minutes’ before they arrived. Per staff interviews conducted, it was revealed that all staff receive a message on their device letting them know which resident is requesting assistance. Normally, the closest staff member to the resident or room will head their way. Staff reported that they receive a notification every four (4) minutes until it is answered. However, they try and get to the resident before it rings for a second time. And if for any reason they are busy or unavailable, the med-techs will take the call and assist. Furthermore, interviews with staff revealed that they have not heard any residents mention that it has taken too long for them to receive assistance after using their pendants or that they have been left on the floor for an extended period of time. Based on the information obtained and reviewed, the allegations “Facility staff left resident on the floor for an extended period of time” and “Facility staff did not respond to resident's call button in a timely manner” are deemed Unsubstantiated at this time.

...Continued on LIC 9099C...

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Guzman-ChavezTELEPHONE: (818) 596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 29-AS-20210917093825
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: 04/01/2022
NARRATIVE
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...Continued from LIC 9099...

Also alleged was facility staff did not accord resident privacy. Facility protocol for staff entering a resident’s apartment is to knock and announce themselves before entering. Interviews with staff revealed that they are aware of the facility’s protocol before entering a resident’s apartment. Some residents will reply to the staff when they knock to let them know it is okay for them to walk in. Other times, it is quiet, and they don’t get a response back when they announce themselves. Staff reported that there have been occasions when the resident may be changing, so they give them a few seconds before entering. Interviews conducted with residents revealed they have not felt their privacy was violated while living at the facility. Also, the staff do routine checks every day to take their temperatures. Additionally, interviews revealed staff knock on the door and wait a few seconds before opening the door and coming inside. Based on interviews, the Department does not have sufficient evidence to support the allegation of “facility staff did not accord resident privacy”. Therefore, the allegation is deemed Unsubstantiated at this time.

It was further alleged that facility staff did not assist resident with medical appointments. It was reported that facility has been cancelling R1’s appointments and say they cannot take them to their appointments and no reason is provided. Per staff interviews conducted, all medical appointments are made by either the resident’s Power of Attorney (POA) or family members. Additionally, the facility arranges for the residents to be transported to their medical appointments as stated in their Admissions Agreement. Interviews with staff also revealed R1 was having their medical appointments made by their spouse while living at the facility. Correspondingly, R1 admitted to having their medical appointments made by their spouse, but also reported that they disliked the fact that they had to book the transportation with the facility in advance. Although the facility only facilitates in coordinating transportation to and from medical appointments, the facility did help coordinate medical appointments for R1. However, facility contacted R1’s family to step in and help out. Interviews with residents revealed some schedule their own medical appointments, while others have their family members schedule it for them. Furthermore, the residents are aware of the days the facility will assist with transportation to their medical appointments to be either Tuesdays or Thursdays. While they would prefer to schedule their medical appointment on different days, they schedule their medical appointments on either one of the days assigned by the facility. Based on the information obtained during the course of the investigation, the Department does not have sufficient evidence to support the allegation of “facility staff did not assist resident with medical appointments”. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview conducted. No citations issued. A copy of report provided via email.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Guzman-ChavezTELEPHONE: (818) 596-4334
LICENSING EVALUATOR SIGNATURE:

DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4