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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801876
Report Date: 10/28/2022
Date Signed: 10/28/2022 02:50:50 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
06/10/2022 and conducted by Evaluator Ashley Smith
COMPLAINT CONTROL NUMBER: 29-AS-20220610141057
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: 124DATE:
10/28/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Brian LariosTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Insufficient staffing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced for a subsequent visit. The LPA met with Executive Director Brian Larios and explained the reason for the visit.

During the initial visit on 6/20/2022, the LPA conducted a tour at 10:20 a.m., observed lunch service from 12:00 p.m. – 12:40 p.m., interviewed staff at 9:15 a.m. and 11:32 a.m., and spoke with residents at 10:30 a.m., 10:43 a.m., 10:50 a.m., and 10:59 a.m., and throughout lunch service from 12:42 p.m. – 1:00 p.m. On 7/11/2022, additional resident interviews took place on 10:10 a.m., and 10:40 a.m. On 10/19/2022, the LPA interviewed staff at 10:32 a.m., 10:38 a.m., and 11:16 a.m., and interviewed nine (9) residents from 9:15 a.m. – 10:30 a.m., and an additional resident interview was conducted at 1:00 p.m. Today, the LPA conducted a tour, reviewed schedules, and interviewed staff at 11:20 a.m., and 11:40 a.m.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
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 6
Control Number 29-AS-20220610141057
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: 10/28/2022
NARRATIVE
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Regarding the allegation: Insufficient staffing

It was alleged that the facility was insufficiently staffed, specifically in the dining room and housekeeping. Interviews confirmed that as a result of staff shortages in the dining room, sections of the dining room had been previously closed to allow for residents to sit in a centralized location rather than throughout the dining room. Staff claimed that there should be three (3) dining staff at breakfast, five (5) dining staff during lunch service, and five (5) to six (6) dining staff during dinner service. It was communicated that there are usually two (2) person for breakfast, three (3) persons during lunch, and four (4) to five (5) staff during dinner. Residents claimed that they understood the wait times, as they expressed that the dining room was understaffed. However, it was confirmed that there were long waits. Some residents also communicated that due to insufficient staffing in the housekeeping department, some experienced not having their apartment cleaned at least once a week. Staff interviews confirmed that although management staff have had to step in to assist, there have been shortages in the housekeeping department. It was communicated that fully staffed in the housekeeping department meant having four housekeepers ad a laundry attendant. However, staff claimed that they tend to have between two (2) to three (3) housekeepers per shift.

Based on interviews and record review, there is sufficient evidence to support the claim of insufficient staffing, specifically in dining and housekeeping. This allegation is deemed Substantiated at this time.

Pursuant to Title 22 Regulations, deficiencies were cited (refer to LIC 9099-D). Exit interview conducted, today's report and appeal rights were issued.

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 29-AS-20220610141057
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
11/04/2022
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements. Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. This requirement is not met as evidenced by:
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The Administrator agreed to the following:
1. Submit a Staffing Plan by 11/4/2022. Staffing Plan shall detail the efforts the licensee has employed to ensure adequate staffing in dining and housekeeping departments. Plan shall detail steps taken in response to call-outs.
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Based on interviews and record review, licensee failed to ensure that the facility had an adequate number of staff to meet the residents needs in dining and housekeeping departments, 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: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
06/10/2022 and conducted by Evaluator Ashley Smith
COMPLAINT CONTROL NUMBER: 29-AS-20220610141057

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: 124DATE:
10/28/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Brian LariosTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not provide a safe and comfortable environment for residents in care
Staff did not provide adequate food service
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced for a subsequent visit. The LPA met with Executive Director Brian Larios and explained the reason for the visit.

During the initial visit on 6/20/2022, the LPA conducted a tour at 10:20 a.m., observed lunch service from 12:00 p.m. – 12:40 p.m., interviewed staff at 9:15 a.m. and 11:32 a.m., and spoke with residents at 10:30 a.m., 10:43 a.m., 10:50 a.m., and 10:59 a.m., and throughout lunch service from 12:42 p.m. – 1:00 p.m. On 7/11/2022, additional resident interviews took place on 10:10 a.m., and 10:40 a.m. On 10/19/2022, the LPA interviewed staff at 10:32 a.m., 10:38 a.m., and 11:16 a.m., and interviewed nine (9) residents from 9:15 a.m. – 10:30 a.m., and an additional resident interview was conducted at 1:00 p.m. Today, the LPA conducted a tour, reviewed schedules, and interviewed staff at 11:20 a.m., and 11:40 a.m.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 29-AS-20220610141057
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: 10/28/2022
NARRATIVE
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Regarding the allegation: Staff did not provide a safe and comfortable environment for residents in care
It was alleged that due to the number of wheelchairs and walkers present during meal service, it poses a safety and tripping hazard. Staff interviews reveal that they inform all residents that ambulate with a walker, wheelchair, or motorized scooter that once they come into the dining room, their device will be placed along the wall and would be retrieved at the close of service. Staff admitted that for some residents, some prefer that their ambulatory device is within arms reach for safety reasons. However, staff said that the majority of the residents comply and are agreeable to the process of having staff move their ambulatory device against the wall and retrieving it at the end of food service. The LPA observed dining service on 6/20/2022 and 10/19/2022 and observed minimal ambulatory devices in the main dining room and observed many around the perimeter of the dining room. Interviews conducted with residents whom use ambulatory assistive devices communicated that staff will place their device against the wall during service; the only concern communicated was near the end of service, it takes time for staff to retrieve their device.

Based on the information obtained, there is insufficient evidence to support the claim that staff did not provide a safe and comfortable environment for residents. This allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Staff did not provide adequate food service


It was alleged that residents were unhappy with the food options. Resident interviews revealed that various food options were available from the specialty and standard menu; however, if concerns were raised regarding meal quality, staff were accommodating and would either change the meal out for the resident or take it back for it to be prepared to their liking. Interviews with kitchen staff revealed that there may be varied time in getting food, depending on meals that are made-to-order, versus specialty items that are made in bulk prior to the start of service. Staff also admitted that due to product limitation from the company’s chosen food vendors, staff are now ordering food in advance to identify which food items are available, and communicating menu changes to the residents in a timely manner. Staff communicated that they are also working at cycling out some meal choices to allow for a variety of new meal options, with understanding that some of the residents may be dissatisfied with some meal options that are temporarily discontinued.

CONT 9099-C

SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 29-AS-20220610141057
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: 10/28/2022
NARRATIVE
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Staff interviews revealed that the facility can offer low salt meals, limited concentrated sweets, and regular diets. A review of Atria’s program plan revealed that the community is unable to offer any other diets. However, staff interviews revealed that they will attempt to assist residents with meal selections for those that are gluten-free or have other dietary substitutions. Most residents whom are on a special diet communicated that they were made aware of the facility's policy as it relates to the dietary restrictions they were able to meet, and said that they selected options that fit their needs.

However, concerns were raised regarding staffing in the dining room and extended wait times to receive food. This was addressed in another allegation and the licensee was cited for insufficient staffing.

Based on the information obtained in interviews and record review, there is insufficient evidence to support the claim that the staff did not provide adequate food service. This allegation is deemed Unsubstantiated at this time.

No deficiencies cited at this time. Exit interview conducted. A copy of the report was issued.
SUPERVISOR'S NAME: Jeralyn Ann PfannenstielTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley SmithTELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6