565801876-10-30-2024-29-AS-KHEN-DAKT6S-20241031142736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801876
Report Date: 10/30/2024
Date Signed: 10/30/2024 10:38:18 AM

Unsubstantiated

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
04/15/2024 and conducted by Evaluator Kelly Dulek

COMPLAINT CONTROL NUMBER: 29-AS-20240415104028

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: 117	DATE:	10/30/2024
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Eden Tolentino, Executive Director		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff do not ensure signal systems calls are answered promptly for residents in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek conducted a subsequent complaint investigation for the allegation listed above. LPA arrived at the facility at 09:40AM and was greeted by front desk staff. At 09:50AM, LPA met with Executive Director (ED) Eden Tolentino. Entrance interview conducted.

During an initial complaint visit conducted on 04/18/2024, LPA interviewed previous ED at 12:02PM, toured the facility at 12:20PM, conducted resident and staff interviews from 12:48 PM to 02:32 PM. Additionally, LPA received copies of pertinent documents. LPA then reviewed all documents obtained and spoke with reporing party related to the allegations. The following was then determined:

It was alleged that residents are waiting too long when requesting assistance by utilizing their call buttons. Interview with staff revealed that the facility utilizes Phillips Lifeline for their resident pendants. Each resident in Assisted Living receives a pendant upon move in and Memory Care residents do not use pendants. Staff
Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

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-20240415104028

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: 10/30/2024

NARRATIVE

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stated that all pendants are inspected monthly to ensure functionality. Staff interviews revealed that staff are assigned a group of residents, however, if one staff is busy, another caregiver will assist the resident. According to staff, typical response time is under 15 minutes. Administrator stated that all call logs are reviewed daily and if response time is greater than 15 minutes, staff need to provide an explanation for the late response. LPA interviewed residents as well, who indicated the care they receive is good and response time is adequate. There was a resident interviewed who indicated they had fallen, but their pendant was not on their body and was not within reach at the time of the fall. So the staff were unaware the resident had fallen. LPA spoke with reporting party who indicated they personally had no concerns with the call times, but had heard from others that they had a problem. Residents interviewed, including those the reporting party identified, indicated there had been no recent concerns related to the call response system. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation "Staff do not ensure signal systems calls are answered promptly for residents in care" is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of today's report was provided.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 10/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/30/2024

LIC9099 (FAS) - (06/04)

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