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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800476
Report Date: 02/26/2021
Date Signed: 02/26/2021 03:27:01 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:ATRIA LAS POSASFACILITY NUMBER:
565800476
ADMINISTRATOR:ROBLOE BABASANTAFACILITY TYPE:
740
ADDRESS:24 LAS POSAS RDTELEPHONE:
(805) 987-9872
CITY:CAMARILLOSTATE: CAZIP CODE:
93010
CAPACITY:140CENSUS: 97DATE:
02/26/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:06 PM
MET WITH:Deedee HigginsTIME COMPLETED:
02:48 PM
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Licensing Program Analyst (LPA) KaSandra Lopez initiated a Case Management - Incident inspection due to a self-reported incident report. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Life Guidance Director Deedee Higgins as Administrator Robloe Babasanta was unavailable.

At 2:06 PM the LPA spoke with Deedee Higgins and explained the reason for today's inspection. On 2/25/2021, Community Care Licensing Division received a self-reported Unusual Incident/Injury Report (LIC 624) pertaining to Resident #1 (R1) and Resident #2 (R2). The alleged incident occurred on or around February 23, 2021.

At 2:39 PM, Ms. Higgins took the LPA on a physical plant tour via FaceTime of the common areas and the second floor. The LPA did not observe any health and safety concerns at this time. The LPA advised Investigations Branch (IB) Investigator Laura Garcia was assigned to the investigation.

Further investigation is needed. The LPA advised she would email Ms. Higgins a list of requested records along with a copy of today's report for signature.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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