331880723-2-13-2023-18-AS-KCLS-CPJTLA-20230302134910

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880723
Report Date: 02/13/2023
Date Signed: 02/13/2023 11:08:40 AM

Unsubstantiated

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
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/25/2020 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 18-AS-20200625081458

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: 5	DATE:	02/13/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Corazon Capalad-Caregiver		TIME COMPLETED:	11:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff yell at resident

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to the facility to deliver findings on the above allegation. LPA met with Corazon Capalad and she was informed of the purpose of the visit and the above allegation.

LPA Allen attempted to interview R1 at the time of the visit but was unsuccessful.

Based on the interviews and file review the above finding is Unsubstantiated. A finding of unsubstantiated means 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.

An exit interview was conducted where this report was discussed and provided to Corazon Capalad at the conclusion of the visit with appeal rights.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 02/13/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2023

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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