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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801876
Report Date: 11/21/2024
Date Signed: 11/21/2024 03:20:47 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
03/14/2024 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20240314110052
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: 116DATE:
11/21/2024
UNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Eden TolentinoTIME COMPLETED:
03:35 PM
ALLEGATION(S):
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Facility staff destroyed residents' personal belongings.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit. LPA met with Executive Director (ED) Eden Tolentino and explained the reason for the visit.

During today's visit, LPA interviewed the ED starting at 11:35, staff 1 (S1) at 12:07 p.m. and staff 2 (S2) at 12:21 p.m. S2 assisted LPA with locating records regarding the medication management for resident 1 (R1). During LPA's previous visit on 3/20/2024, LPA interviewed staff and R1.

Regarding the allegation facility staff destroyed R1's personal property, this complaint was specifically about staff destroying R1's over-the-counter supplements and/or medications.

(continued on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
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-20240314110052
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
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 OAKS
FACILITY NUMBER: 565801876
VISIT DATE: 11/21/2024
NARRATIVE
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(continued from LIC9099)


R1 had a hospital stay starting on or about 6/22/2023. On 8/15/2023, R1's physician sent a new medical assessment to the facility indicating R1 could no longer store or manage their own medications. Facility staff removed all medications, including over-the-counter medications/supplements, from R1's room. Facility staff ensured they received orders from R1's physicians for all of the medications and supplements. Any medications that had a change of dose or were discontinued were destroyed.

Medication destruction records show there were medications destroyed on 8/25/2023, 10/3/2023, 1/17/2024, and 1/25/2024, which included some over-the-counter supplements/medications. Records from R1's physician showed there were supplements that were discontinued between 11/20/2023 - 12/8/2023, including Vitamin B-12 and Folic Acid. Those supplements were destroyed. There were other medications which were discontinued or changed; those were also destroyed.

On 1/22/2024, R1's physician completed a medical assessment indicating R1 was capable of storing and managing their own medications. On 2/1/2024, the facility completed a new Service Plan indicating R1 no longer required medication management. Records show all medications, including supplements, the facility was storing and managing for R1 were released to R1.

Based on information obtained, the facility staff did indeed destroy some of R1's medications and over-the-counter supplements. However, R1's physician had submitted a list to the facility indicating which medications, including supplements, were discontinued or had a change in dosage. The destruction of these medications and supplements occurred during the period when the facility was managing R1's medications due to R1's physician stating the need for medication management. Therefore, this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and report issued.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 593-4347
LICENSING EVALUATOR NAME: Teresa CamaraTELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:

DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/21/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2