565801876-12-9-2022-29-AS-ASMH-CLXPEW-20221209101550

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801876
Report Date: 12/09/2022
Date Signed: 12/09/2022 10:16:13 AM

Document Has Been Signed on 12/09/2022 10:16 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
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: 124	DATE:	12/09/2022
TYPE OF VISIT:	POC	UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Brian Larios and Sarah Dodd		TIME COMPLETED:	10:20 AM

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Licensing Program Analyst (LPA) Ashley Smith conducted an unannounced Plan of Correction inspection due to deficiencies observed during the investigation of complaint control # 29-AS-20220610141057.

During the initial visit on 06/20/2022, the LPA observed several areas in which there appeared to be a ‘hole’ or a noticeable dip in the flooring. The licensee was cited for 87303(a) Maintenance and Operation, and the licensee was required to communicate a plan of action regarding the floor repairs, as it was highlighted as an extensive project. On 07/01/2022, the Executive Director communicated a tentative plan that the repairs would begin in August or September of 2022. It was noted that the licensee planned to remove the carpet, refinish the subfloor, and place new flooring over the subflooring.

A subsequent visit was conducted on 10/28/2022 and it was determined that floor repairs had not begun. The licensee was re-cited under 87303(a) Maintenance and Operation. During that visit, it was communicated that the licensee will send a layout of the building, indicating the flooring sections that will require repair no later than 11/9/2022. The licensee had until 11/28/2022 to complete the project. If the licensee required an additional thirty (30) day extension, the request for a thirty (30) days extension needed to be communicated before 11/28/2022. The LPA followed up with Executive Director Brian Larios on 11/10/2022, whom communicated that the facility had been unable to secure a vendor at that time, despite best efforts. The LPA reiterated the time frame to complete the project, and the fact that the licensee could ask for a thirty (30) day extension. As of today, the licensee failed to submit a layout of the building to indicate the sections that require repair, nor did the licensee submit a request for an extension by 11/28/2022.

Civil Penalties will be issued for period between 11/29/22 - 12/09/22, which is a total of eleven (11) days, at $100.00 per day. Civil Penalties will accrue until plan of correction is met.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D). 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: 12/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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