331880723-4-28-2021-18-AS-EMAN-C2KKF5-20210430075118

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880723
Report Date: 04/15/2021
Date Signed: 04/28/2021 09:53:45 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/09/2019 and conducted by Evaluator Stephanie Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20191009101925

FACILITY NAME:	ATIENZA RESIDENTIAL CARE		FACILITY NUMBER:	331880723
ADMINISTRATOR:	ARMSTRONG, CAROLINE		FACILITY TYPE:	740
ADDRESS:	1328 GALAXY DR		TELEPHONE:	(909) 792-3835
CITY:	BEAUMONT	STATE: CA	ZIP CODE:	92223
CAPACITY:	6	CENSUS: 1	DATE:	04/15/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Caroline Armstrong		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Resident sexually abused by staff resulting in injuries
Staff neglect resulting in resident's fall
Staff failed to provide adequate supervision resulting in resident hitting another resident which caused injuries

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Stephanie Williams contacted the facility in order to deliver findings for the above allegations. LPA contacted the Administrator via telephone due to the COVID-19 pandemic. LPA discussed the purpose of the call with Administrator, Caroline Armstrong. The investigation consisted of interviews and records review.

In regards to allegation #1, Interviews conducted during the course of investigation revealed that R1 was hospitalized around early October 2019 due to an infection, not determined to be related to sexual abuse. Based upon review of records and additional interviews, it could not be determined that R1 was sexually abused by staff. The allegation of sexual abuse is UNSUBSTANTIATED.

In regards to allegation #2, Interviews with the administrator revealed that while in a private room, R1 fell out of bed and on to the floor. Further interviews revealed that when staff heard the fall, staff immediately went into R1's room to assess R1. No reported injuries on R1 were observed, according to staff. Staff interviews

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021

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 18-AS-20191009101925

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ATIENZA RESIDENTIAL CARE	FACILITY NUMBER: 331880723
	VISIT DATE: 04/15/2021

NARRATIVE

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Interviews further revealed that there were two facility staff at the time of the fall. Three residents were in care. Interviews with residents revealed that staff checks on residents at least every 3 hours. Evidence was not found to support that due to staff neglect of R1 resulted in fall. The allegation is UNSUBSTANTIATED.

In regards to allegation #3, Interviews with staff revealed that no resident has hit another resident and that staff is always present in the facility amongst the residents. Interviews with Resident 2 (R2) revealed that no resident on resident altercation was ever witnessed. Investigation did not reveal corroborating evidence to support that a resident hit another resident causing injury. The allegation is UNSUBSTANTIATED

A finding that the allegation is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged abuse occurred.

An exit interview was conducted where this report (LIC 9099 & LIC 9099C) was discussed and a copy of this report was provided to the Administrator via email.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie Williams	TELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021

LIC9099 (FAS) - (06/04)

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