565801876-5-6-2022-29-AS-JAPL-CE6S2B-20220506132915

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801876
Report Date: 05/06/2022
Date Signed: 05/06/2022 10:36:56 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
05/03/2022 and conducted by Evaluator Ashley Smith

COMPLAINT CONTROL NUMBER: 29-AS-20220503103617

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: 114	DATE:	05/06/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Brian Larios		TIME COMPLETED:	10:40 AM

ALLEGATION(S):

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Facility is malodorous
Facility equipment in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ashley Smith arrived unannounced for an initial 10-day visit. The LPA met with Excecutive Director Brian Larios and explained the reason for the visit.

During today’s visit, the LPA interviewed staff at 9:10 a.m., 9:16 a.m., and 9:20 a.m., observed the facility dining area from 9:23 a.m. – 9:27 a.m.; and, interviewed residents from 9:45 a.m. – 10:00 a.m.

Regarding the above allegations, it was alleged that the salad bar was inoperable, and an odor was emitting from the area where the salad bar is placed in the dining area.

CONT 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

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-20220503103617

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: 05/06/2022

NARRATIVE

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Staff interviews revealed that approximately four to six weeks ago, a sewage smell was emitting from the area where the salad bar was placed. Records review confirmed that on 4/4/2022, a plumbing company came out to service the plumbing issue and the licensee was notified that the issue was corrected. However, the smell returned, and the Administrator continued to communicate with the plumbing company in efforts to resolve the issue in a timely fashion. It was discovered that there were two pipes connected to the salad bar. As such, on 4/30/2022, a plumbing company returned to the facility to continue working on the plumbing issue. Interviews confirmed that in order to address the sewage smell, the plumbing company had to ‘cap’ the pipes leading directly to the salad bar. As a result, it makes the salad bar inoperable at this time. Interviews confirmed that due to the COVID-19 pandemic, the facility stopped utilizing the salad bar for safety and sanitary purposes. Residents were informed that they could still order salads, yet they would be ordered through dining staff and prepared in the kitchen.

During today’s visit, the LPA observed the salad bar that is placed in the dining room. At this time, the LPA could not identify a malodorous or unpleasant smell emitting from the area. Interviews conducted with staff and residents confirmed that at this time, there is no smell coming from the salad bar. Lastly, the salad bar is currently inoperable, yet it is due to the need to ‘cap’ the pipes leading to the salad bar, as it has caused the odor.

Based on the information obtained, there is insufficient evidence to support the above allegations. The Administrator has made efforts to address the malodorous smell on numerous occasions and in order to properly address it, the pipes had to be capped to stop the smell. As a result, the current salad bar is inoperable cannot be utilized. The Administrator claimed that they are planning to either remove the mechanism altogether or will replace the salad bar in the near future. 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 Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Ashley Smith	TELEPHONE: (818) 421-9032
LICENSING EVALUATOR SIGNATURE:	DATE: 05/06/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/06/2022

LIC9099 (FAS) - (06/04)

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