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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565801876
Report Date: 02/14/2024
Date Signed: 02/14/2024 03:00:15 PM


Document Has Been Signed on 02/14/2024 03:00 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:ATRIA GRAND OAKSFACILITY NUMBER:
565801876
ADMINISTRATOR:BRIAN LARIOSFACILITY TYPE:
740
ADDRESS:2177 E THOUSAND OAKS BLVDTELEPHONE:
(805) 370-5400
CITY:THOUSAND OAKSSTATE: CAZIP CODE:
91362
CAPACITY:140CENSUS: 109DATE:
02/14/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Brian Larios, Executive DirectorTIME COMPLETED:
03:05 PM
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Licensing Program Analyst (LPA) Christine Yee conducted an unannounced 24 hour case management visit to investigate the incident reported to the Department on 2/12/24 regarding Resident #1 being abused by Staff #1. LPA Yee initially met with Sarah Dodd, Community Business Director upon arrival. Brian Larios was contacted via telephone and he arrived at 11:25am to conduct the visit. The reason for today's visit was explained.

On today's visit, LPA Yee conducted an interview with Brian Larios, Executive Director at 11:38am, an attempted interview with Resident #1 at 11:26am, telephone interview with Staff #3 at 1:38pm and attempted telephone interviews with Staff #1 at 1:58pm and Staff #2 at 1:21pm. Video camera footage was reviewed at 12:48pm and a copy taken at 1:08pm. Copies of facility documents were collected throughout the visit.

Based on the information obtained during today's visit, additional interviews need to be conducted and other information collected before a final decision can be made and the appropriate course of action to be taken regarding the resolution of this incident. At this time, information was provided that Staff #1 is no longer employed at the facility and does not pose a further threat to Resident #1 while the investigation is being conducted.

Exit interview was conducted.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Christine YeeTELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024
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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