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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880723
Report Date: 07/29/2026
Date Signed: 07/29/2026 03:32:18 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
03/05/2026 and conducted by Evaluator Paola Guerrero
COMPLAINT CONTROL NUMBER: 56-AS-20260305093912
FACILITY NAME:ATIENZA RESIDENTIAL CAREFACILITY NUMBER:
331880723
ADMINISTRATOR:ARMSTRONG, CAROLINEFACILITY TYPE:
740
ADDRESS:1328 GALAXY DRTELEPHONE:
(951) 845-3565
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY:6CENSUS: 5DATE:
07/29/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Caroline ArmstrongTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Licensee does not ensure facility have a certified administrator
Resident sustained an injury while in care
Staff did not ensure resident was handled appropriately during a transfer
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Administrator Caroline Armstrong and explained the purpose of the visit regarding the allegations stated above.

First allegation: Licensee does not ensure facility have a certified administrator. Regarding the allegation stated above, LPA conducted a walkthrough of the facility and observed administrators’ certificates to be posted. Upon review of records LPA observed Administrator Certificate to have an expiration date of 5/26/2021. LPA conducted an interview with Facility Administrator regarding the alleged allegation Administrator informed LPA that a current Administrators Certificate has yet to be issued. LPA conducted an admin certificate search through department website and discovered that the current Administrator is listed under the pending certificate list and not listed under the active Administrators list.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 56-AS-20260305093912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ATIENZA RESIDENTIAL CARE
FACILITY NUMBER: 331880723
VISIT DATE: 07/29/2026
NARRATIVE
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Second allegation: Resident sustained an injury while in care. Regarding the allegation stated above, LPA conducted an interview with Resident #1 responsible party (RP), regarding the alleged allegation RP indicated to LPA that Resident #1 had unexplained bruise and a scrape on their right ankle. RP provided images of R#1 injury and indicated that R#1 is listed as non-ambulatory and requires assistance in transferring in and out of bed and dressing. LPA conducted an interview with Staff #1 who informed LPA that staff did not report R#1 injury and indicated that injury could have happened during the time staff was assisting R#1 with transfer.

Third allegation: Staff did not ensure resident was handled appropriately during a transfer. Regarding the allegation stated above, LPA conducted an interview with Resident #1 responsible party regarding the alleged allegation RP reported to LPA that Resident #1 Preplacement Appraisal listed under services that R#1 was listed as non-ambulatory and required help with transferring. RP reported that while Resident #1 was being transferred, staff did not handle R#1 appropriately which resulted in R#1 to sustain an unexplained injury to R1 right ankle. LPA conducted an interview with Staff #1 regarding the alleged allegation and Staff #1 informed LPA that injury could have happened during the time staff was assisting R#1 with transfer. Based on the evidence gathered during the investigation, the above allegations are Substantiated. A finding that the complaint is Substantiated means that the findings are valid because the preponderance of the evidence standard has been met. Title 22 Regulations, from division 6, chapter, article 6, is, cited on the attached LIC 9099 D.

An exit interview was conducted where this report, appeal rights, and LIC9099-D was discussed, and a copy of the report was provided to Facility Administrator Caroline Armstrong the conclusion of the visit.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 56-AS-20260305093912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ATIENZA RESIDENTIAL CARE
FACILITY NUMBER: 331880723
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2026
Section Cited
CCR
87411(a)
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Personnel Requirements – General 87411 (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.

This requirement is not met as evidence by:
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The Licensee has agreed to read over regulation: Personnel Requirements – General. And provide training to all care staff regarding the safety precautions when transferring or assisting residents in care. The Licensee will provide LPA with proof of training signed and dated by all staff and shall provide the training to LPA by POC 8/14/2026.
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Based on observation and record review, the licensee did not adhere to the regulation resulting in R#1 to sustain an unexplained injury while being transferred, which poses an immediate Health, Safety, or Personal Rights risk to people in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 56-AS-20260305093912
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ATIENZA RESIDENTIAL CARE
FACILITY NUMBER: 331880723
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/29/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/14/2026
Section Cited
CCR
87785(b)(d)(1)
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87785 Initial Certification Training Program Vendor and Program Approval Requirements …(b) Any vendor applicant seeking approval of an Initial Certification Training Program shall submit a written request to the Department’s Administrator Certification Section using the Request for Course Approval form LIC 9140 and the Vendor Application/Renewal form LIC 9141. The request shall be signed by an authorized representative of the vendor applicant certifying that the information submitted is true and correct, and contain the following:…(d) A written request for renewal of the Initial Certification Training Program shall be submitted to the Department’s Administrator Certification Section using the Request for Course Approval form LIC 9140 and the Vendor Application/Renewal form LIC 9141, and shall contain the information and processing fee specified in Section 87785(b)….(1) A vendor must have a current approved Residential Care Facilities for the Elderly Initial Certification Training Program in order to renew its Residential Care Facilities for the Elderly Initial Certification Training Program vendorship.

This requirement is not met as evidence by:
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The Licensee has agreed to read over regulation: Initial Certification Training Program Vendor and Program Approval Requirements. And ensure to pay recertification fees and take the necessary classes to renew Administrators Certification. Licensee will provide LPA with proof of payment and proof of the completion of Admin courses by POC 8/14/2026.
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Based on observation and record review, the licensee did not adhere to the regulation listed above by operating a facility without a current administrator’s certificate, which poses an immediate Health, Safety, or Personal Rights risk to people in care.
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Type B
08/14/2026
Section Cited
CCR
87468.1(a)(3)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: … (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment….(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.
This requirement is not met as evidence by:
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The Licensee has agreed to read over regulation: Personal Rights of Residents in All Facilities. And provide training to all care staff regarding the safety and wellbeing of residents in care. The Licensee will provide LPA with proof of training signed and dated by all staff and shall provide the training to LPA by POC 8/14/2026.
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Based on observation and record review, the licensee did not adhere to the regulation resulting in R#1 to sustain an unexplained injury, which poses an immediate Health, Safety, or Personal Rights risk to people in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4