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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191592479
Report Date: 08/08/2024
Date Signed: 08/08/2024 04:13:08 PM

Document Has Been Signed on 08/08/2024 04:13 PM - 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ATRIA COVINAFACILITY NUMBER:
191592479
ADMINISTRATOR/
DIRECTOR:
ALONDRA FUENTESFACILITY TYPE:
740
ADDRESS:825 W SAN BERNARDINO RDTELEPHONE:
(626) 967-9621
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 90CENSUS: 62DATE:
08/08/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Brooke Lamotte, Resident Service DirectorTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Tao conducted an unannounced Case Management- Incident visit in response to resident’s Incident Report, dated 07/24/24. The facility has a capacity of 90 residents and licensed to serve elderly residents age 60 and above. The facility is approved for fifty-six (56) non-ambulatory residents. LPA met with and explained the purpose of today's visit to Brooke Lamotte, Resident Service Director who assisted with this visit.

During today's visit LPA toured the facility, interviewed staff /resident and reviewed resident's file. The incident report stated resident said to the administrator that staff slapped resident’s hands and not allowed resident to use restroom on resident’s initial request. LPA interviewed staff, it revealed the facility had investigated this incident and Brooke called police when she aware of the incident. The Covina Police come to investigate, and the finding was unfound. Police report # 24-16416. Per resident interview, resident stated the suspected abuser staff had slapped resident’s hands multiple times and resident reported no injuries by felt sad about the incidents. Regardless, the administrator decided to let go the suspected abuser staff on 7/25/24. The facility provided the in-service training to facility staff on 8/4/24 regarding abuses and mandated reporter. LPA obtained copies of Staff /Resident roster; Resident’s Identification/Emergency Contact Information (facesheet), Needs and service plan; Unusual Incident Report; Physician Report; In-service training documents and Employee Corrective action plan (let go the staff).

LPA did not observe nor identify signs of neglect, abuse or other immediate health and safety threats. No deficiencies were observed and cited during this visit. Exit interview held and a copy of the report was provided.
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Bonnie Tao
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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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