191592479-7-14-2023-28-AS-RORN-CX6VGW-20231101162610

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592479
Report Date: 07/14/2023
Date Signed: 07/14/2023 04:53:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/05/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20230705160321

FACILITY NAME:	ATRIA COVINA		FACILITY NUMBER:	191592479
ADMINISTRATOR:	ALONDRA FUENTES		FACILITY TYPE:	740
ADDRESS:	825 W SAN BERNARDINO RD		TELEPHONE:	(626) 967-9621
CITY:	COVINA	STATE: CA	ZIP CODE:	91722
CAPACITY:	90	CENSUS: 63	DATE:	07/14/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Alondra Fuentes, administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff abused resident while in care.
Staff failed to provide adequate food service.
Staff isolated resident in resident's room

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Tao conducted an unannounced complaint investigation for the allegations listed above today. During today’s visit, LPA met with Alondra Fuentes, administrator upon arrival. LPA explained the purpose of today's visit to staff.

Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #4 (S4); interviews of residents from resident#1 (R1) through resident #7 (R7); reviewed resident#1’s record reviews, and a facility tour. LPA obtained copies of the staff and resident rosters, resident#1’s files and documents with relevant information.

In regard of the allegation, “staff abused resident while in care,” it was alleged that resident#1 (R1) was abused by staff since resident had not paid rent for months.

(-continued in LIC 9099 C-)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

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 28-AS-20230705160321

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ATRIA COVINA	FACILITY NUMBER: 191592479
	VISIT DATE: 07/14/2023

NARRATIVE

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

The investigation revealed the following: Per R1’s interview, staff abused R1 due to R1’s rent had not paid rent for months. Per interviews of other residents, six (6) out of seven (7) residents interviewed could not corroborate the allegation. Resident interviews revealed that staff did not abuse residents. All four (4) staff who were interviewed denied the allegation. Staff interviews revealed facility had policy on resident abuses and in service training to ensure residents’ right. Staff would be reported and terminated if abused residents. Therefore, staff did not abuse resident while in care.

In regard of the allegation, “staff failed to provide adequate food service,” it was alleged that resident#1 (R1) did not receive lunch and adequate food services. The investigation revealed the following: LPA interviewed R1, resident indicated facility did not provide side dishes and miss breakfast food trays sometimes. Six (6) out of seven (7) residents interviewed could not corroborate the allegation. Resident interviews revealed that residents always received three (3) meals with side dishes and drink daily. Snacks and alternate food menu were available. Six (6) out of seven (7) residents indicated they had never missed a meal. Four (4) staff who were interviewed denied the allegation. Staff interviews revealed adequate food services were provided to residents. Per file review, facility had weekly food menu and posted in kitchen. LPA toured the kitchen, LPA observed food menu posted on the kitchen wall and had 2 days of perishable food supplies with variety. Therefore, there is not preponderance evidence to prove the facility had failed to provide adequate food service.

In regard of the allegation, “staff isolated resident in resident’s room,” it was alleged that resident#1 was not allowed to be outside of resident’s room or use the computer room. The investigation revealed the following: interviewed with R1, resident stated staff did not allow R1 to be outside of resident’s room or use the computer room. Six (6) out of seven (7) residents interviewed could not corroborate the allegation. Resident interviews indicated residents are free to be outside and use computer room. Four (4) staff interviewed were denied the allegation. Staff interviews revealed residents had resident’s rights to go to places as they wished. Per reviewing staff training records, staff had in-service training on resident rights. Therefore, facility staff did not isolate resident in resident’s room.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore, the allegations is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2