191592479-1-16-2026-28-AS-FFIS-DRE2RC-20260217163710

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191592479
Report Date: 01/16/2026
Date Signed: 01/16/2026 01:45:56 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
05/01/2025 and conducted by Evaluator Sanjay Vaid

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250501163701

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: 67	DATE:	01/16/2026
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Administrator Crystene Char		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not dispense medications to resident as prescribed.
Staff did not provide resident’s representative with requested records in a timely manner.
Licensee charged resident for services not received.

INVESTIGATION FINDINGS:

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****The reason for the amendment is to remove confidential information listed on the initial report dated 12/12/25. The findings will remain unsubstantiated. **

Licensing Program Analyst (LPA) Vaid conducted a subsequential visit to deliver the findings for the above-mentioned allegations. Met with Crystene Char, toured the facility and did not observe any health and safety concerns.

On 05/06/25, Licensing Program Analyst (LPA) S Vaid conducted an initial 10-day complaint investigation visit for the above allegations. LPA met with Irina Sarkisyan, Community Business Director, Crystene Char, Administrator was notified, Administrator arrived shortly after, and complaint was discussed. LPA Vaid and Administrator Char did not observe any safety concerns during the facility tour.

The investigation consisted of the following: LPA toured the physical plant. LPA Interviewed staff 1-7 (S1-S7), and residents #2-#8 (R2-R8) resident R1 is currently in skilled nursing home. LPA requested, collected, and reviewed documents from R1's face sheet, physicians reports, admissions agreement, preplacement Assessment, medication log MARs, list of residents’ medications, plan of care and service plan and copies of four (4) random residents: face sheet, physician reports, admissions agreement, preplacement assessments, and medication list. Telephone contact information about staff and residents. Staff and residents’ rosters.
CONTINUED ON 9099C………………….

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026

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 28-AS-20250501163701

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ATRIA COVINA	FACILITY NUMBER: 191592479
	VISIT DATE: 01/16/2026

NARRATIVE

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The investigation revealed the following:

Regarding the allegation: Staff did not dispense medications to resident as prescribed. It is alleged that the staff did not dispense and administer medications to resident#1 (R1) as prescribed. Seven (7) of seven (7) staff interviewed denied this allegation. Staff interviewed stated they dispensed and administered R1’s medication as listed on the prescribed physicians’ orders received. The medications not transferred from R1’s previous pharmacy were communicated to R1’s physician on 04/01/25 and the facility pharmacy was awaiting insurance approval for the medication. Staff stated they communicated the medication and pharmacy issue to R1 and their POA’s to help resolve. Seven (7) of eight (8) residents interviewed could not corroborate this. According to the records reviewed medication list received dated 4/01/25 listed fourteen (14) medications, Nine (9) medications with four (4) PRN’s and one (1) medication on hold. Staff awaited approval from R1’s insurance for the remainder. R1 moved to the facility on 04/01/25 and was admitted to the hospital on 4/15/25. Records show R1 was administered medications dosage correctly from the MARs log dated 04/01/25 to 04/15/25, staff dispensed and R1 was administered their medication as prescribed. Based on LPAs records reviewed and interviews which were conducted. Although the allegation 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 allegation is unsubstantiated.

Regarding the allegation: Staff did not provide resident’s representative with requested records in a timely manner. It is alleged that the staff did not provide resident #1(R1) representatives with requested medication records in a timely manner. Seven (7) of seven (7) staff interviewed denied the allegation. Seven (7) of eight (8) residents could not corroborate this allegation. According to staff interviewed, records request is handled by the resident service director and administrator. R1’s POA request for records was communicated to the administrator and request for medication records was provided to R1’s POA within five (5) days. Request for records was made on 4/18/25 and records were provided to R1’s POA on 4/23/25 by the staff at Atria. Based on LPAs records reviewed and interviews which were conducted. Although the allegation 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 allegation is unsubstantiated.

CONTINUED 9099C………..

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250501163701

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ATRIA COVINA	FACILITY NUMBER: 191592479
	VISIT DATE: 01/16/2026

NARRATIVE

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Regarding the allegation: Licensee charged resident for services not received. It is alleged that the Licensee has charged Resident #1(R1) for services not received. Resident #1 being overcharged with the room rental rate, only having lived in the community for two weeks. Seven (7) of seven (7) staff interviewed denied this allegation. Seven (7) of eight (8) residents could not corroborate this allegation. According to record review, R1 signed and dated the admissions agreement and is therefore held responsible for rental payment until the end of April. Thirty (30)day notice to leave the community was sent the administrator on 4/18/25, R1 is responsible for the payment of the room rental until 05/18/25, as agreed in the admissions agreement dated 03/31/2025 by R1. Based on LPAs records reviewed and interviews which were conducted. Although the allegation 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 allegation is unsubstantiated.

Copy of this report was provided to Administrator Crystene Char.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Sanjay Vaid
LICENSING EVALUATOR SIGNATURE:	DATE: 01/16/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2026

LIC9099 (FAS) - (06/04)

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