565801876-4-8-2021-29-AS-JAPL-C223B5-20210412180547

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801876
Report Date: 04/07/2021
Date Signed: 04/08/2021 10:09:03 AM

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
09/09/2020 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20200909161931

FACILITY NAME:	ATRIA GRAND OAKS		FACILITY NUMBER:	565801876
ADMINISTRATOR:	KRIS WALUSZKO		FACILITY TYPE:	740
ADDRESS:	2177 E THOUSAND OAKS BLVD		TELEPHONE:	(805) 370-5400
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY:	140	CENSUS: 84	DATE:	04/07/2021
		UNANNOUNCED	TIME BEGAN:	09:25 AM
MET WITH:	Brian Larios		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility staff did not provide for resident's dietary needs
Facility staff did not notify the resident's authorized representative of a change in the resident's condition

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced at 9:25am for a subsequent complaint investigation. The LPA met with Executive Director Brian Larios and explained the reason for the visit.

During a 9/15/2020 visit, the LPA interviewed staff at 4:10pm and 4:20pm, and requested documents pertinent to the investigation. Additional staff interviews were conducted on 11/3/2020 at 2:06pm, 2:11pm, 2:27pm and 2:47pm. During today’s visit, six staff interviews were conducted between 9:41am – 11:22am, and seven resident interviews were conducted between 11:57am – 2:06pm.

Allegation: Facility staff did not provide for resident's dietary needs
It was alleged that the dietary needs for Resident #1 (R1) was not met, and R1 was only offered fried foods and sweets. R1’s Physician Report(s) dated 2/1/2019 and 7/29/2020 indicated that R1 was on a low-salt diet, and the 7/29/2020 Physician’s Report noted that R1 was diabetic. Lastly, there was a Special Diet Clarification Form, in which R1’s primary care physician noted that R1 should not have added salt or concentrated sweets.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

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 29-AS-20200909161931

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 GRAND OAKS	FACILITY NUMBER: 565801876
	VISIT DATE: 04/07/2021

NARRATIVE

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A review of the facility menus for the months of March-September 2020 indicated that although the menu had less options than previously offered, residents still were afforded options. Interviews with dining staff confirmed that most of the food is considered low-salt, and seasoning is provided as requested. In addition, the facility menus represented that there were low-sugar dessert options for residents that could not consume concentrated sweets. However, resident interviews indicated that whereas they were dissatisfied with the options provided, they confirmed that the served food still able to meet dietary needs as necessary. Residents reiterated that they were able to select what was on the menu at will, and that they were not forced to eat anything that they did not want to eat. Interviews, including those whom cared for R1 and served meals to R1, revealed that R1 had the choice to pick foods that fit their dietary standards, yet R1 was free to select meals that they wanted. Staff said that they were unable to force residents to eat certain foods, yet staff stated that they would regularly remind R1 of their dietary limitations. Staff claimed that R1 would often adhere to their prescribed diet, but often would select other options to their liking.

Based on the information obtained, there is insufficient evidence to support the claim that the facility staff did not provide for resident’s dietary needs. Staff claimed that they would remind R1 of their limitations, but R1 would still opt to eat what they desired. The menus reviewed indicated that the residents still had the option to eat foods that were prescribed per their dietary limitations, yet residents would opt to choose food of their liking. This allegation is deemed Unsubstantiated at this time.

Allegation: Facility staff did not notify R1's authorized representative of a change in the resident's condition

It was alleged that R1 suffered a change of condition and the responsible party was not notified. Interviews and records reviewed indicated that R1 began displaying a cognitive decline in March 2020. Beginning in approximately April 2020, the facility began to electronically send completed and updated assessments to the authorized representative(s) via email and would obtain electronic signatures. The LPA reviewed email communication from 4/15/2020, 5/14/2020 and 6/5/2020, indicating that R1’s authorized representative had reviewed the updated assessment for R1. Minimal updates were noted on the April 2020 and May 2020 assessments, yet the assessment completed in June 2020 indicated that R1 required assistance with incontinent care, needed status checks, and assistance with housekeeping and laundry services.

In addition, the LPA reviewed internal facility communication logs to identify where R1’s authorized representative was contacted regarding any changes. Due to COVID restrictions, the statewide Stay-At-Home Order, and direction from local health department and the local licensing agency, residents were required to stay in their rooms and were unable to visit the other residents.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20200909161931

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 GRAND OAKS	FACILITY NUMBER: 565801876
	VISIT DATE: 04/07/2021

NARRATIVE

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This directive was also communicated to residents and their authorized representative. As such, staff were instructed to check in on the residents more frequently to assess for any changes of condition. There was an incident on 6/12/2020 where R1 was transported to the emergency room due to an observed change of condition. Additional records indicated that R1 was admitted to a skilled nursing facility on 6/19/2020. After further review, it was discovered that R1 was admitted due to a behavior of visual hallucinations, refusing care, suicidal ideations, increased confusion and forgetfulness. The skilled nursing facility felt that R1’s condition had improved and discharged R1 back to the facility on 7/28/2020. Upon readmittance back to the facility, R1 was noted as having edema in both legs, dry scabs, and noted confusion. Unfortunately, R1 suffered a fall on 8/1/2020 and after an assessment from the paramedics, R1 refused to go to the hospital. Thereafter, the fire department arrived on 8/2/2020 at the request of R1 whom called them, as R1 suffered another fall. R1 was transported to the hospital as they complained of back pain, and R1 was moved out of the community in September 2020. R1's representative was notified of all the above-mentioned events.

Based on the information obtained, there is insufficient evidence to support the claim that the facility did not notify the authorized representative of a change of condition. The facility regularly updated R1's representative of any changes, and with every update, the authorized representative received an updated assessment which documented the changes. Unfortunately due to COVID restrictions and restrictions imposed by the Stay At Home order, residents were instructed to stay in their room. Yet staff conducted regular observations of residents and documented all changes of conditions. Furthermore, while R1 was at the skilled nursing facility (SNF), there a discussion about moving R1 to the memory care unit. However, after returning to the facility from their stay at the SNF for approximately six weeks, R1 was hospitalized within the week, and did not return to the facility. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited. Exit interview conducted. Signatures obtained. A copy of the report was emailed.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 04/07/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2021

LIC9099 (FAS) - (06/04)

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