331880723-6-28-2021-18-AS-EMAN-C67PBX-20210824111104

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880723
Report Date: 06/28/2021
Date Signed: 06/28/2021 04:06:38 PM

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
03/01/2021 and conducted by Evaluator Natalie Gayoso

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210301131529

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:	06/28/2021
		UNANNOUNCED	TIME BEGAN:	01:29 PM
MET WITH:	Caroline Armstrong		TIME COMPLETED:	04:16 PM

ALLEGATION(S):

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Staff did not adequately supervise resident.
Staff member yelled at resident.
Facility does not provide a comfortable environment for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Natalie Gayoso made an unannounced visit to the facility to conclude investigations of the above allegations and deliver findings. LPA was greeted and allowed entrance by Administrator Caroline Armstrong. LPA explained the purpose of today's visit.

LPA conducted interviews with revelent parties. The first allegation indicates staff did not adequately supervise resident. Interview with Administrator stated Resident #1 (R1) has never been placed on the couch and has not had any falls while being at the facility. R1 would be placed in their wheel chair at times, but was scared of getting out of bed due to pain and/or scared of falling. Interview with Staff #2 (S2) stated R1 was never placed on the couch. R1 did not like their leaving room and would stated it was due to being scared. R1 never stated why they were scared but would refuse to be taken out of room. LPA interviewed Witness #1 (W1) whom stated the S2 would constant check on R1 and provided adequate supervision.

The second allegation indicates staff member yelled at resident. Interview with Administrator stated they have

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie Gayoso	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

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-20210301131529

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: 06/28/2021

NARRATIVE

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never witnessed S2 yell at R1. R1 would yell day and night regarding their son and at times confused S2 as being their son. S2 stated they have never yelled at R1. R1 would yell all day and night while at the facility. S2 would go check on R1 when they began tol yelling and ask what was wrong. S2 stated R1 would always reply that nothing was wrong. W1 stated that they have never witnessed S2 yell at R1 when they would come to the facility.

The third allegation states facility does not provide a comfortable environment for resident. Administrator stated staff constantly check on residents in care and treat them with respect and dignity. While R1 was in care, they never were scared nor acted uncomfortable around staff. W1 stated staff took good care, were profession, and provided a comfortable environment while R1 was at the facility.

Based on interviews, which were conducted, the allegations are UNSUBSTANTIATED. A finding of Unsubstantiated means that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted and a copy of this report were provided to Administrator

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Natalie Gayoso	TELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:	DATE: 06/28/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/28/2021

LIC9099 (FAS) - (06/04)

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