Atria Santa Clarita.

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an annual inspection. LPA met with Executive Director Tracy Paulk who was present during inspection. The entire facility has (3) floors, which (67) residents may be bedridden on the 1 st and 2 nd floor of villas 1 & 2. There is a hospice waiver for (13), and fire clearance approved for delayed egress for the Memory Care, located in villa 2. The current census is 103. Facility license/sketch, rights of resident council, grievance/complaint procedures, emergency disaster plan, resident bill of rights, personal rights, rights of resident council, discrimination notice, theft and loss policy, activity schedule, and evacuation plan visibly posted. Common areas: The first floor, identified the front entrance lounge with a hospitality station that serves coffee, water, and tea. The Administration offices, beauty salon, resident’s rooms, and laundry were also observed. All areas were clean and appropriately furnished for resident’s comfort. Passageways were free from obstruction, and inside temperature was comfortable. The second and third floor consists of resident rooms, dining room, activity, fitness, snack room, mail room, and personal laundry equipment for residents. The third floor also has movie and game room, and library. Dining Room and Kitchen: Passageways were free from obstruction, with adequate lighting. There is a daily menu placed on the table, with chairs and table were comfortable and clean. There are a variety a healthy foods. Coffee, tea, and water is available throughout the day, as well as a variety of snacks. LPA inspected the food supply and kitchen area where food is stored and prepared. LPA observed licensing requirements of (2) day perishable and (7) day non-perishable. Kitchen area was clean and food was stored and wrapped in a safe and health manner. Due to time constraints, LPA was not able to complete the annual inspection and will return at a later date and time to complete. Exit interview and copy of report provided to Administrator.

Licensing Program Analyst (LPA) Tuesday Cabiness conducted a case management visit regarding an incident report submitted to Licensing concerning Resident #1 (R1) being observed leaving the facility unassisted. According to the incident report, staff observed R1 walking on the sidewalk outside of the community. Staff escorted R1 back to the facility. The report further stated that R1 exited the facility through the back gate and was not immediately observed by staff. During today’s visit, LPA met with Resident Care Director Venca Avivi, who confirmed that R1 left the facility. Venca reported that R1 is physically capable of leaving the facility; however, per physician’s orders, R1 is not permitted to leave unassisted due to physical limitations, not cognitive impairment. Venca stated that R1 was taken to urgent care by R1’s daughter and was diagnosed with a urinary tract infection (UTI), which may have contributed to the incident. Facility staff reported there are currently no concerns regarding R1. The facility will continue to monitor R1 closely and document any changes in condition. LPA obtained and reviewed R1’s current physician’s report. At this time, no further review is required. During the visit, LPA also identified concerns regarding the facility Administrator on record, Eden Tolentino. According to Eden, her designated back-up Administrator is Chad Jones, who resides in Kentucky when Eden is not present at the facility. LPA spoke with Eden via telephone. Eden reported she has not been physically present at the facility since January 05, 2026, and stated that Chad Jones has been present full time. ( See LIC809C) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA requested submission of an updated LIC 308 (Designation of Administrative Responsibility) and LIC 501 (Personnel Report), reflecting the days and hours the Administrator is working at the facility. At this time, there is no full-time Administrator physically present at the facility. Eden reported she is fulfilling the Administrator licensing requirements. LPA will follow up with Eden and Chad regarding the requested documentation. An exit interview was conducted, and a copy of this report was provided to Venca Avivi.

A review of the Admissions Agreement states , “…we will reassess your needs to determine whether your condition has changed, work with you to update your service plan, if necessary, and review it with you”. During interviews, staff stated facility will meet with R1 or their responsible party on 01/08/2026 to discuss the details and changes in the level of care and the increased fees associated with such changes. Based on interviews and record review, there is enough information to verify the allegation, therefore, the allegation is SUBSTANTIATED at this time. Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 9099-D): No other health and safety hazards noted during the visit. Exit interview conducted and a copy of the report was issued.

Over time, however, R1’s health declined, and R1 became a fall risk. Facility staff appropriately documented this decline and implemented preventative measures in collaboration with R1’s medical providers. Based on the available documentation and lack of corroborating evidence, there is insufficient evidence to support the allegation. Therefore, the allegation is deemed Unsubstantiated at this time. Exit interview conducted and copy of report provided to Executive Director.

Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced annual inspection. LPA was greeted by front the receptionist. Executive Director (ED) April Princesa was not present during the initial inspection, but came shortly after. The entire facility has (3) floors, which is licensed for (160) non-ambulatory, of which (67) may be bedridden on the 1 st and 2 nd floor of villas 1 & 2. There is a hospice waiver for (13), and fire clearance approved for delayed egress for the Memory Care, located in villa 2. The current census is 123. Facility license/sketch, rights of resident council, grievance/complaint procedures, emergency disaster plan, resident bill of rights, personal rights, rights of resident council, discrimination notice, theft and loss policy, activity schedule, and evacuation plan visibly posted. Common areas: The first floor, identified the front entrance lounge with a hospitality station that serves coffee, water, and tea. The Administration offices, beauty salon, resident’s rooms, and laundry were also observed. All areas were clean and appropriately furnished for resident’s comfort. Passageways were free from obstruction, and inside temperature was comfortable. The second and third floor consists of resident rooms, dining room, activity, fitness, snack room, mail room, and personal laundry equipment for residents. The third floor also has movie and game room, and library. Dining Room: Passageways were free from obstruction, with adequate lighting. There is a daily menu placed on the table, with chairs and table were comfortable and clean. LPA observed residents eating a variety and healthy food for lunch. Coffee, tea, and water is available throughout the day, as well as a variety of snacks. Resident Rooms : All apartments are provided with a microwave and refrigerator purchased by the facility. Rooms, floors, walls, and carpet areas were clean in good repair. Residents are allowed pets. Inside temperature was cool, and each resident has there own thermostat to regulate. Bathrooms: All were clean, with grab bars, non-skid mats, and shower chairs. There are emergency pull cords located by the toilet for emergency purposes. Residents also have emergency pendants. Due to time constraints, the annual was not able to be completed. LPA will continue inspection at another date and time; reviewing staff, resident, training and medication records and the memory care unit. Exit interview and copy of report provided to ED.

Therefore, based on documentation and interviews, the allegation is Unsubstantiated at this time. Allegation # 2: It was alleged staff failed to provide resident's authorized representative with incident reports. During the initial investigation, on June 06/07/2023, from 1130am to 2pm, LPA conducted interviews and obtained resident records, as well reviewed facility documents. During today’s visit, from 930am to 230pm, LPA conducted additional interviews and re-reviewed documents. It was reported to LPA by the family, that they requested incident reports of (R1) falling at the facility. LPA interviewed staff, who denied there was a request of any documentation for (R1). It was revealed to LPA, that the former Life Guidance Director was no longer working at the facility, and the request could have been directed to her. The family could not specifically identify who they requested the documents to. Therefore, based on interviews, LPA does not have enough evidence to prove the allegation, and it’s Unsubstantiated at this time. Exit interview and copy of report provided.

Regarding the allegation: Staff are illegally evicting resident: it’s being alleged that R1 was given a 30-day notice to pay or quit due to failure to pay their rent since January, 2023. LPA Spaeth received a copy of the 30-day notice to pay or quit letter issued to R1 on 5/04/2023. The letter clearly stated R1’s account is past due in the amount of $25,833.95, which represents a past due balance for the months of January through May, 2023. LPA Spaeth interviewed R1 on 5/30/2023 at 11:00 am who stated they did not remember receiving an eviction notice and could not remember if they were up to date with their payments. LPA Spaeth interviewed R1 today, 8/16/2024 at 11:00 am who stated they have made all their payments to the facility. LPA Spaeth spoke to the Business Director, Wendy Rose on 8/12/2024 at 4:00 pm who stated R1 has made all their outstanding payments. Based upon interviews and record review, the allegation is unsubstantiated . Regarding the allegation: Staff obtained & billed a resident for services not agreed upon: it’s being alleged that the facility told R1 they require supervision when leaving the facility and there would be a monthly additional charge. It’s also being alleged R1 was given a letter stating R1 requires this service and there would be an additional monthly charge for the service each month. LPA reviewed R1’s Admissions Agreement. R1 moved into the facility as of July, 2022. The Admissions Agreement states “Assessment of Your Needs which states a rate change will occur when the change in service occurs due to a resident’s need for a service change. Facility will then review the assessment with the resident.” LPA Spaeth reviewed the physician’s report (LIC 605C) which reveals R1 will need assistance when leaving the facility. LPA interviewed the Resident Services Director (S1) who stated they conducted the yearly assessment for R1 and reviewed the assessment with R1 each year. S1 confirmed R1 was aware they needed assistance when leaving the facility and also told R1 the charge would be indicated on their bill as a “private duty personnel” charge. LPA Spaeth spoke to R1 at 11:00 am who stated they were aware they would be charged for staff assistance when they left the facility. LPA Spaeth interviewed R2 – R10 who confirmed they have never been charged for services they have not agreed upon. Based upon record review, staff and residents’ interviews, the allegation is unsubstantiated . Continued on 9099C 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Regarding the allegation: Staff did not provide requested records to resident's authorized representative. It’s being alleged that a resident's authorized representative requested copies of the resident’s records and did not receive them. LPA Spaeth was informed the records requested have been received by the requester. Therefore, the allegation is unsubstantiated . Exit interview conducted and a copy of the report was given.

Licensing Program Analyst (LPA) Tuesday Cabiness arrived at the facility at 9:30am to conduct Annual inspection. LPA was greeted by front the receptionist, who notified the Executive Director (ED) April Princesa, and who was informed the reason of the visit. The entire facility has (3) floors, which is licensed for (160) non-ambulatory, of which (67) may be bedridden on the 1 st and 2 nd floor of villas 1 & 2. There is a hospice waiver for (13), and fire clearance approved for delayed egress for the Memory Care, located in villa 2. The current census is 132. Facility license/sketch, rights of resident council, grievance/complaint procedures, emergency disaster plan, resident bill of rights, personal rights, rights of resident council, discrimination notice, theft and loss policy, activity schedule, and evacuation plan visibly posted. Common areas: LPA conducted a physical plant tour with (ED) April, and inspected the first floor, which identifies front entrance lounge with a hospitality station with coffee, water, and tea. The Administration offices, beauty salon, resident’s rooms, and laundry were also observed. All areas were clean and appropriately furnished for resident’s comfort. Passageways were free from obstruction, and inside temperature was comfortable. The second and third floor consists of resident rooms, activity, fitness, snack room, mail room, and personal laundry equipment for residents. The third floor also has movie and game room, and library. Dining Room: Passageways were free from obstruction, with adequate lighting. There is a daily menu placed on the table, with chairs and table were comfortable and clean. LPA observed residents eating a variety and healthy food for lunch. Coffee, tea, and water is available throughout the day, as well as a variety of snacks. Resident Rooms : All apartments are provided with a microwave and refrigerator purchased by the facility. Rooms, floors, walls, and carpet areas were clean in good repair. Residents can have pets, and during inspection, LPA observed cats and dogs signs posted on resident's doors. Thermostat, smoke alarms, and carbon monoxide detectors were being tested during the inspection, hired by Johnson Control Inc, (JCI) company. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Bathrooms: All were clean, with grab bars, non-skid mats, and shower chairs. There are emergency pull cords located by the toilet for emergency purposes. Residents also have emergency pendants. Water temperature was measured in several of the rooms. Memory Care Unit : Is located adjacent to the Assisted Living facility. It has (3) floors, with a delayed egress front door and keypad lock located outside the facility. The current census is (38). Rooms are either private or separated, with (1) shared bathroom. All common areas were clean and in good repair. Passageways were free from obstruction, and furnishings were appropriate for residents. There is a dining room, kitchen, and activity room for resident’s entertainment and comfort. Snacks, water, and tea are available throughout the day. Meals are prepared by the main kitchen and delivered to the unit. Smoke alarm and carbon monoxide detectors are in each resident room. . Record Review : Medication room was locked and inaccessible to residents. There is a complete first aid kit at the facility. Residents and staff records were reviewed. LPA reviewed files of randomly selected residents. Files included signed admission agreements, current appraisals, current medical assessments, physician orders for medications and centrally stored medication logs. Medications appear to be given as prescribed. Residents files appear to be complete and updated. Staff present files were also reviewed, staff files appear to be complete and updated training is computerized. First aid and medication training current. No health and safety hazards noted during the visit. **Note, inspection tool questions for staff and residents did not populate and LPA was not able to complete them. Exit interview conducted and copy of report provided to Administrator.