565801876-2-7-2023-29-AS-ASMH-CNTUCG-20230207142755

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801876
Report Date: 02/07/2023
Date Signed: 02/07/2023 02:28:17 PM

Document Has Been Signed on 02/07/2023 02:28 PM - It Cannot Be Edited

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 GRAND OAKS		FACILITY NUMBER:	565801876
ADMINISTRATOR:	BRIAN LARIOS		FACILITY TYPE:	740
ADDRESS:	2177 E THOUSAND OAKS BLVD		TELEPHONE:	(805) 370-5400
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY:	140	CENSUS: 120	DATE:	02/07/2023
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Brian Larios		TIME COMPLETED:	02:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Ashley Smith conducted an unannounced Plan of Correction inspection due to deficiencies observed during the investigation of complaint control # 29-AS-20220610141057.

In summary, the facility was cited on 06/20/2022 for 87303(a) Maintenance and Operation, due to the claim that there were several areas on the second and third floor of the facility that required repair.

A subsequent visit was conducted on 10/28/2022 and it was determined that floor repairs had not begun. The licensee was re-cited under 87303(a) Maintenance and Operation. During that visit, it was communicated that the licensee will send a layout of the building, indicating the flooring sections that will require repair no later than 11/9/2022. The licensee had until 11/28/2022 to complete the project. If the licensee required an additional thirty (30) day extension, the request for a thirty (30) days extension needed to be communicated before 11/28/2022. As of 12/09/2022, the Department did not receive a request for an extension, nor did the community submit a layout of the sections that required repairing. On 12/09/2022, civil penalties were issued in the amount of $1,100 for the period between 11/29/22 - 12/09/22 due to failure to comply with the Plan of Correction. The licensee was made aware that penalties would accrue at $100 per day until the corrections were made.

On 12/12/2022, the LPA participated in a virtual conference call with Atria, in which a plan was communicated as to when the facility would begin floor repairs. It was communicated that the flooring will be an extensive project, yet management communicated their commitment in gaining regulatory compliance, and came to an agreement to temporarily eliminate any tripping hazards observed on the second and third floor. Interviews and documentation supported claims that the repairing of the subflooring took place on 12/16/2022.

The Plan of Correction is met at this time. However, civil penalties will be issued from the period between 12/10/2022 - 12/16/2022, which is a total of seven (7) days, at $100.00 per day.

No additional deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2023

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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