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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801876
Report Date: 08/20/2025
Date Signed: 08/20/2025 02:39:11 PM

Substantiated


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
07/23/2025 and conducted by Evaluator Kelly Dulek
COMPLAINT CONTROL NUMBER: 29-AS-20250723095127
FACILITY NAME:ATRIA GRAND OAKSFACILITY NUMBER:
565801876
ADMINISTRATOR:EDEN TOLENTINOFACILITY TYPE:
740
ADDRESS:2177 E THOUSAND OAKS BLVDTELEPHONE:
(805) 370-5400
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY:140CENSUS: 128DATE:
08/20/2025
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Eden TolentinoTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff do not provide adequate food service
Staff do not ensure the facility is clean and sanitary
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Kelly Dulek arrived at the facility unannounced to conduct a subsequent complaint investigation for the allegations listed above at 10:10AM. Upon arrival, LPA met with Executive Director (ED) Eden Tolentino. Entrance interview conducted.

During today's visit, LPA interviewed ED, toured the dining room area with ED at 10:27AM, interviewed Resident #1 (R1) at 10:40AM, and LPA observed lunch. During an initial complaint visit conducted by LPA Angela Barutyan on 07/31/2025, LPA conducted a physical plant tour between 12:24PM-01:30PM, conducted interviews with five (5) residents and four (4) staff between 12:25PM-01:20PM, reviewed and obtained copies of pertinent documents relevant to the investigation, and discussed allegations with ED Remon Pagels. The following was then determined:

Report Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
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 2
Control Number 29-AS-20250723095127
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: 08/20/2025
NARRATIVE
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The complaint alleges that on 07/17/2025, the meal served during dinner service was not prepared properly, with the meat and potatoes undercooked. R1 brought this concern to the ED at that time. Interview with ED revealed that on that specific date, the beef cooked was prepared cooked medium and that R1 prefers their beef well done. Staff interviewed stated residents can make requests about cooking preference as well as alterations to their preferred entree. This information is then relayed from the serving staff to the cook staff to accommodate the residents. In the case of R1, R1 had not asked for their meat to be served well done, so R1 was served the meal as prepared. Interviews with staff revealed that on that date, once the food was served and the chef was made aware, the chef did reheat R1's beef and potato to their preference. On another unknown date, R1 was concerned that the cornbread was undercooked. R1 saved the cornbread in their refrigerator since the date it was served. LPA observed the cornbread did appear to be moist in the center, but it is unclear how much moisture gathered while the item was stored in the refrigerator and how much was present when the cornbread was served. Other residents interviewed indicated the food served is to their liking; many commented that the chef is excellent. The posted menu contains a variety of items in all food groups. There is also an everyday menu, with items residents can choose as an alternative to the meal served. Some residents indicated these everyday items are not always available, but there are choices.

Additionally, R1 was concerned about the cleanliness of the dining room tables and chairs. LPA observed the dining chairs, which consist of a wood frame and padded seating. Observation of the chairs revealed the chairs are older and the varnish on the chairs is wearing, producing a somewhat sticky cloudy appearance on the wood portion of the chairs. ED stated that all the chairs are being sanded and re-varnished due to the appearance. Approximately 25 chairs have been refinished by the maintenance staff. Due to the dry time of the varnish, repairs need to be made after dinner service is completed and chairs dry overnight to not interrupt resident use. To expedite the process, the facility is contracting with an outside vendor to complete the remaining chairs and re-finish the tables as well. Both staff and residents interviewed stated the tables and chairs are wiped down after every use. Based on observation, it appears the concern is with the pedestal stands for the tables, not the table tops and the backs of the chairs.

During the inspection, the LPA observed the tables and chairs to have some buildup and the food was reportedly underdone on specific occasions, however, LPA determined there is no impact direct impact to the residents, presented no danger, and did not effect the overall operation of the facility. This is considered a technical violation and no citations are being issued at this time.

Exit interview conducted. A copy of today's report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Kelly Dulek
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2