565801876-10-12-2021-31-AS-KHEN-C86SMY-20211026140043

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801876
Report Date: 10/12/2021
Date Signed: 10/12/2021 11:44:42 AM

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
03/30/2020 and conducted by Evaluator Kelly Dulek

COMPLAINT CONTROL NUMBER: 31-AS-20200330093523

FACILITY NAME:	ATRIA GRAND OAKS		FACILITY NUMBER:	565801876
ADMINISTRATOR:	CARMY JEROME		FACILITY TYPE:	740
ADDRESS:	2177 E THOUSAND OAKS BLVD		TELEPHONE:	(805) 370-5400
CITY:	THOUSAND OAKS	STATE: CA	ZIP CODE:	91362
CAPACITY:	140	CENSUS: 95	DATE:	10/12/2021
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Marco Perez, Maintenance Director		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Residents are being forced to stay in their rooms

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kelly Dulek initiated an unannounced subsequent complaint investigation for the purpose of delivering findings for the allegation listed above. LPA met with Maintenance Director Marco Perez. Executive Director was unavailable during today’s visit. Entrance interview conducted.

During today’s visit, LPA Dulek and Maintenance Director Marco Perez toured the facility at 10:05AM. No health and safety hazards were observed at that time. During the initial visit on 04/09/2020, LPA Dulek conducted a telephone visit and interview with the Administrator Carmy Jerome at 4:25PM. On 04/10/2020, LPA conducted a FaceTime visit to interview residents from 1:05-2:04PM. LPA then conducted a virtual facility tour with the administrator at 2:10PM. The LPA requested copies of the staff schedule for the current week. The LPA then conducted 3 staff interviews telephonically on 04/30/2020 from 1:05PM-1:35PM and also 4:03-4:19PM. Additionally, during the course of the investigation, LPA reviewed state-issued and county-issued documents related to the complaint allegation. The following was then concluded:
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: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

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 31-AS-20200330093523

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: 10/12/2021

NARRATIVE

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A stay safe at home order was issued on 03/17/2020 and subsequently modified on 03/20/2020. This order indicated those age 65 and older were to “self-isolate in their place of residence to the maximum extent feasible to slow the spread of COVID-19 to the maximum extent possible.” Ventura County Public Health issued a stay well at home order indicating “all individuals currently living within Ventura County, equal to or older than 75 years of age, or equal to or older than 70 years of age with an active or unstable comorbidity, are ordered to shelter at their place of residence from March 18, 2020 to April 1, 2020.” Interviews revealed that although residents may not like staying in their individual apartments, most residents have no problem doing so. Some residents come out of their room to walk around and are then gently reminded to return to their room for their safety. No residents interviewed felt they have been forced to stay in their rooms. Additionally, interviews revealed that the facility is offering exercise and social opportunities in the doorways to keep residents entertained and healthy while practicing social distancing. No witnesses interviewed have ever seen staff raise their voice or physically return residents to their room. Based on documents reviewed and interviews, although the allegation may have happened or is valid, there is insufficient evidence to prove the allegation did occur, therefore, the allegation that “residents are being forced to stay in their rooms” is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of the report was provided via email.

SUPERVISOR'S NAME: Kristin Heffernan	TELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Kelly Dulek	TELEPHONE: (951) 836-3170
LICENSING EVALUATOR SIGNATURE:	DATE: 10/12/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2021

LIC9099 (FAS) - (06/04)

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