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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565800476
Report Date: 04/01/2022
Date Signed: 04/01/2022 12:04:37 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
08/04/2020 and conducted by Evaluator Martha Guzman-Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20200804120922
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: 118DATE:
04/01/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Robloe BabasantaTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Resident's room was not properly maintained
Resident was not provided a comfortable accommodations
Resident was not properly groomed while in care
Resident's laundry needs are not being met while in care
Resident was charged for services not received
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 8/07/2020 by LPA K. Heffernan and a subsequent visit was conducted on 8/02/2021 and 3/22/2022 by LPA Martha Guzman Chavez. On today’s visit, LPA Guzman Chavez met with Executive Director (ED), Robloe Babasanta. Entrance interview conducted.

During the initial visit on 8/07/2020, LPA Heffernan conducted a telephonic interview with Executive Director, Babasanta at 10:01 a.m. On 8/02/2021, LPA Guzman Chavez conducted a physical plant tour, interviewed the ED, three (3) staff, seven (7) random residents, and obtained copies of pertinent documents relevant to the investigation. On 8/25/2021, the LPA also interviewed three (3) resident family members at 11:16 a.m., 12:50 p.m., and 1:15 p.m. On 3/22/2022, between 10:00 a.m. and 11:30 a.m., LPA Guzman Chavez conducted interviews with the ED and six (6) residents. The LPA also observed six (6) random resident bedrooms and obtained copies of pertinent documents.
...Continued on LIC 809C...
Substantiated
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 8
Control Number 29-AS-20200804120922
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: 04/01/2022
NARRATIVE
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...Continued from LIC 809...

It was alleged that Resident's room was not properly maintained and R1’s care had been neglected during their time at the facility as there was a terrible smell coming from inside the room. It was reported that Resident 1’s (R1’s) room was unkept and the room smelled like urine and feces. It was further reported that inside the room were a water bottle that had mold, soiled clothes stacked in the tub, and rotten trash that was not taken out. Interviews with R1’s family members revealed that they were ‘appalled at the state of their room’. Interviews with the staff revealed that housekeeping is done once a week and reported that ‘sometimes caregivers will call housekeeping if a resident’s room is too dirty in between’. Interviews with residents confirmed that housekeeping is done once a week. Additionally, interviews with residents revealed that everything gets charged, ‘if it is not in your care plan, they will add it to your bill’. Correspondingly, interviews with random resident family members revealed that when they have previously visited, the room is not messy, although it could be a bit cleaner. Also, Interviews with random resident family members revealed that they had visited the resident and the smell of urine was lingering around and were concerned as they stated, ‘the bed is still wet while they’re lying there…’. They had previously requested a fan to dry out the mattress because they were only making the bed but not drying it out. Interview with the ED revealed the facility was not short staffed due to the pandemic and if they were short staffed, agency staff came in and helped out when needed. Additionally, the level of care displayed what services came standard. As far as laundry and taking out the trash, that is a standard service that comes included in the level 4 care plan. Furthermore, record review revealed photos that of which displayed clothes all over the living room, mold on the straw of R1’s water bottle, and soiled clothes in the bathtub. Per Admissions Agreement signed on 1/17/2020, it states on page 5 of 44, under bullet point 2-Our Services, ‘we provide the following standard services for the stated monthly rate: weekly linen laundry service and cleaning of apartments’. However, R1’s room was not properly maintained while living at the facility. Based on the information and records obtained and reviewed, the allegation of “Resident's room was not properly maintained” is deemed Substantiated at this time. Additionally, based on interviews and record review, the allegation that “Resident was not provided a comfortable accommodations” is deemed Substantiated at this time.

...Continued on LIC 809C...

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 8
Control Number 29-AS-20200804120922
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: 04/01/2022
NARRATIVE
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...Continued from LIC 809C...

It was also alleged that resident was not properly groomed while in care. Information gathered during the course of the investigation revealed R1 was admitted to the facility on 1/18/2020. Per R1’s Resident Functional Needs Assessment Pre-Move in, dated on 1/14/2020, noted R1 to require limited assistance, two (2) times per day for grooming. Limited Assistance under grooming states ‘requires assistance with preparation of grooming materials for grooming and/or minimal assistance grooming’. Furthermore, the Resident Functional Needs Assessment Move In, dated 1/23/2020 maintained the same level of care under ‘Grooming’ as limited assistance, two (2) times per day as the Resident Functional Needs Assessment Change in Plan dated 6/02/2020. Additionally, per Physicians Report dated 6/23/2020, it stated R1 required assistance of another person for basic ADL’s including bathing, dressing, grooming, toileting, managing own cash resources, and was at risk if allowed direct access to personal grooming and hygiene items. Per interviews conducted, basic grooming is part of level 4 care plan, which is the level of care R1 was receiving while living at the facility. Record review of photos portrayed R1 had been unkept and ungroomed for months prior to moving out. Based on all information gathered during the course of the investigation, the above allegation, “Resident was not properly groomed while in care” is deemed Substantiated at this time.

It was also alleged that Resident's laundry needs are not being met while in care. It was reported that inside the room were soiled clothes stacked in the bathtub. Per interviews conducted, it was revealed that laundry includes staff taking the clothes, washing, drying, and folding, and it is up to the resident to put clean folded clothes away. However, per R1’s Physicians Report dated 1/20/2020, R1’s primary diagnosis included: deconditioning, general weakness, gait, balance disorder, and due to a heart attack years before, R1 had paralysis on the left side. Furthermore, R1 required one person assist with ADL’s including bathing, dressing, and toileting needs. After laundry was brought back to R1’s room, it was to be put away by the care staff. Interviews with the ED revealed laundry being put away by care staff was a standard service that came with the level 4 care plan. However, record review revealed photos displaying clothes in the bathtub and on the sofa. Based on the information and documentation obtained and reviewed, the allegation of “Resident's laundry needs are not being met while in care” is deemed Substantiated at this time.

...Continued on LIC 809C...

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 8
Control Number 29-AS-20200804120922
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: 04/01/2022
NARRATIVE
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...Continued from LIC 809C...

It was further alleged that Resident was charged for services not received. It was reported that the facility was responsible for R1’s grooming, laundry, and tidying up the room, and the facility was sending bills reflecting those items in care. Interview with the ED revealed grooming, putting clean laundry away, and throwing out the trash was part of R1’s care plan. Per Physicians Report dated 6/23/2020, it stated R1 required assistance of another person for basic ADL’s including bathing, dressing, grooming, toileting, and managing own cash resources. And Resident Functional Needs Assessment Change of Condition dated 6/02/2020, stated, ‘requires two (2) person on all transfer for safety.’ Thus, R1 was unable to complete any of those tasks themselves and required the assistance of the care staff. Hence, R1 was admitted to the facility with the care plan that best suited them at the moment which included grooming, laundry, and throwing out the trash as part of the standard services offered for that level of care plan. Furthermore, records revealed photos which displayed R1’s room to have soiled clothes stacked in the tub, rotten trash that was not taken out, and R1 to be ungroomed. Based on the information and records obtained and reviewed, the allegation of “Resident was charged for services not received” is deemed Substantiated at this time.

Pursuant to CCR, Title 22, Division 6, Chapter 8, the following deficiencies are cited (Refer to LIC LIC9099-D).



Exit interview conducted. Citation issued. Appeal Rights discussed. 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 8
Control Number 29-AS-20200804120922
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2022
Section Cited
CCR
87468.1(a)(2)
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87468.1(a)(2) Personal Rights of Residents in All Facilities. Residents in all residential care facilities for the elderly shall have all of the following personal rights: to be accorded safe, healthful and comfortable accommodations…

This requirement is not met as evidenced by:
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The ED will conduct an in-house training with all staff pertaining to Title 22 Regulation 87468.1 - Personal Rights of Residents in All Facilities and submit proof. Submit to CCL by 4/30/22.
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Based on interviews and record review, the licensee did not comply with the section cited above as they failed to maintain R1’s room clean resulting in smelling of urine and/or feces which poses a potential health risk to residents in care.
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Type B
04/30/2022
Section Cited
CCR
87303(a)(f)(1)
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87303(a)(f)(1) – Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times… Solid waste shall be stored, located and disposed of in a manner that will not permit the transmission of a communicable disease or of odors…

This requirement is not met as evidenced by:
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The ED will submit plan on how you will ensure resident rooms are maintained in a clean and sanitary condition and submit the cleaning log for the month of April 2022. Submit to CCL by 4/30/22.
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Based on interviews and record review, the licensee did not comply with the section cited above as they failed to ensure the facility removed trash from the R1’s room which poses a potential health risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
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 appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 29-AS-20200804120922
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/01/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2022
Section Cited
CCR
87464(f)(1)
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87464(f)(1) Basic Services. Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).

This requirement is not met as evidenced by:
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The ED has agreed to submit a Statement of Understanding explaining the steps the facility will follow to avoid similar issues from happening again regarding meeting basic care needs of the residents. Submit to CCL by 4/30/2022.
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Based on the investigation, the licensee did not comply with the section cited above, as the facility did not ensure that R1’s basic care needs such as grooming were met, which poses a potential health and safety risk to residents in care.
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Type B
04/30/2022
Section Cited
CCR
87464(f)(2)
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87464(f)(2) - Basic Services. Basic services shall at a minimum include… Safe and healthful living accommodations and services, as specified in Section 87307, Personal Accommodations and Services.

This requirement is not met as evidenced by:
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The ED will conduct an in-house training with housekeeping that will include basic services training. Submit to CCL by 4/30/22.
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Based on interviews and record review, the licensee did not comply with the section cited above, as they failed to ensure the residents laundry needs were met which poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
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 appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/01/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 8
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
08/04/2020 and conducted by Evaluator Martha Guzman-Chavez
COMPLAINT CONTROL NUMBER: 29-AS-20200804120922

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: 118DATE:
04/01/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Robloe BabasantaTIME COMPLETED:
12:05 PM
ALLEGATION(S):
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Resident's dental needs are not being met while in care
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 8/07/2020 by LPA K. Heffernan and a subsequent visit was conducted on 8/02/2021 and 3/22/2022 by LPA Martha Guzman Chavez. On today’s visit, LPA Guzman Chavez met with Executive Director, Robloe Babasanta. Entrance interview conducted.

During the initial visit on 8/07/2020, LPA Heffernan conducted a telephonic interview with Executive Director, Babasanta at 10:01 a.m. On 8/02/2021, LPA Guzman Chavez conducted a physical plant tour, interviewed the Executive Director, three staff, seven random residents, and obtained copies of pertinent documents relevant to the investigation. On 8/25/2021, the LPA also interviewed three resident family members at 11:16 a.m., 12:50 p.m., and 1:15 p.m. On 3/22/2022, between 10:00 a.m. and 11:30 a.m., LPA Guzman Chavez conducted interviews with the ED and six residents. The LPA also observed six random resident bedrooms and obtained copies of pertinent documents.
...Continued on LIC 809C...
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: 7 of 8
Control Number 29-AS-20200804120922
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: 04/01/2022
NARRATIVE
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...Continued from LIC 809C...

It was alleged that Resident's dental needs are not being met while in care. It was reported that R1 lost a tooth due to lack of dental hygiene while at the facility. Per interviews conducted, all medical appointments are made by either the resident’s Power of Attorney (POA) or family members. Furthermore, the facility will only assist the residents with transportation to and from their medical appointments. Additionally, per Admissions Agreement signed on 1/17/2020, it states on page 5 of 44, under bullet point 2-Our Services, ‘we provide the following standard services for the stated monthly rate: assisting in arranging your transportation to medical and dental appointments…’.However, arranging the actual medical and/or dental appointment would be up to the POA or family members. Based on the information and documentation obtained and reviewed, the Department does not have sufficient evidence to support the allegation of “Resident's dental needs are not being met while in care”. 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: 8 of 8