565800476-8-3-2021-31-AS-KHEN-C5TL2R-20210812082243

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565800476
Report Date: 08/03/2021
Date Signed: 08/03/2021 06:53:00 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
12/05/2019 and conducted by Evaluator Angel Ascencio

COMPLAINT CONTROL NUMBER: 31-AS-20191205163847

FACILITY NAME:	ATRIA LAS POSAS		FACILITY NUMBER:	565800476
ADMINISTRATOR:	BERARD, MARTHA C		FACILITY TYPE:	740
ADDRESS:	24 LAS POSAS RD		TELEPHONE:	(805) 987-9872
CITY:	CAMARILLO	STATE: CA	ZIP CODE:	93010
CAPACITY:	140	CENSUS: 125	DATE:	08/03/2021
		UNANNOUNCED	TIME BEGAN:	03:21 PM
MET WITH:	Robloe Babasanta		TIME COMPLETED:	04:33 PM

ALLEGATION(S):

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Resident is not getting her needs met.
Facility is failing to adhere to a special diet for the resident.
Resident was placed at the facility against her will.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angel Ascencio made an unannounced visit to the facility at approximately 3:25 PM on 08/03/2021 to deliver the finding regarding the above allegations. LPA was met by staff and explained the reason for the visit.

The Department received a complaint on 12/05/2020 that indicated resident #1 (R1) was not getting their needs met, as R1 would like a private caregiver. Interview with R1 on 5/28/2020 at 2:28 pm revealed that R1 feels that the facility is not meeting their needs as they would like to have a private caregiver with them when they go to the doctors and the facility does not provide that. Interview with Administrator on 4/29/2020 at 3:03 pm revealed that R1 has a private caregiver for 4 hours a day, 3 times a week for doctor appointments and grocery shopping.

Continued on LIC 809-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

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 31-AS-20191205163847

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 LAS POSAS	FACILITY NUMBER: 565800476
	VISIT DATE: 08/03/2021

NARRATIVE

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An additional concern is that the facility is failing to adhere to R1’s special diet as the facility is not providing the food that R1 needs and it is making R1 sick. Interview with R1 on 5/28/2020 at 2:28 pm, revealed that facility would meet with R1 to go over menus. R1 stated that there were a couple of weeks that they did not receive the menus. R1 stated that there were times that R1 would refuse to meet with the chef. Interview with the Administrator on 4/29/2020 at 3:03 pm, revealed that chef and the Administrator would go to R1’s room weekly and spend an hour making up a modified menu for R1.

Administrator stated that R1 would pick and choose what they wanted to eat. Administrator stated that R1 would make up their own rules regarding their diet and would insist on eating foods that were not part of their modified diet. Administrator also stated that R1 would bring in foods from outside that they were not supposed to be eating. R1 records on reviewed on 5/28/2020 starting at 1:25 pm shows that the Resident Functional Needs Assessment dated 10/3/19 indicates that R1 has a physician’s ordered specific diet which R1 cannot manage on their own and staff reviews weekly meals with R1. In addition, a food list is provided to kitchen staff weekly. LPA observed weekly menus from 11/3/19 to 12/8/19, which the Administrator indicated that they reviewed with R1 to accommodate their dietary restrictions.

Lastly, it is being alleged R1 was placed at the facility against their will. Interview with R1 on 5/28/2020 at 2:28 pm, revealed that they were not placed at the facility against their will they. R1 stated that they were unable to stay at the place that there were previously living at so their family member showed them the room at this facility and paid the rent so that they could move in. R1’s records reviewed on 6/2/2020 starting at 8:22 am revealed that R1’s lease agreement was signed by R1’s family member. Based on the information obtained during the course of the investigation, the above allegations are deemed UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of this report issued via email.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Angel Ascencio	TELEPHONE: 747-230-3888
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021

LIC9099 (FAS) - (06/04)

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