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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336400075
Report Date: 08/21/2020
Date Signed: 08/21/2020 08:28:31 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:ATRIA HACIENDAFACILITY NUMBER:
336400075
ADMINISTRATOR:BARTON, ROBERTFACILITY TYPE:
740
ADDRESS:44600 MONTEREY AVETELEPHONE:
(760) 341-0890
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:266CENSUS: 155DATE:
08/21/2020
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
08:05 PM
MET WITH:Juden Uy, Medication Assistant
Yanira Sical, Resident Services Assistant		TIME COMPLETED:
08:30 PM
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Licensing Program Analyst (LPA) Tricia Danielson contacted the facility via telephone for the purpose of serving an immediate exclusion letter. This visit is being conducted via telephone and Facetime video conference due to COVID-19 and for precautionary measures. LPA met with Juden Uy, Medication Assistant (MA) and Yanira Sical, Resident Services Assistant (RSA) informed them of the purpose of the visit. MA stated he was the designated person in charge at the time of LPA's virtual visit.

The Department determined that the presence of Karen Martinez Valenzuela in a facility licensed by the Department of Social Services constitutes a threat to the safety to residents in care, therefore orders the facility to remove Karen Martinez Valenzuela. LPA verified through a Facetime virtual tour of the facility conducted by RSA and MA that Karen Martinez Valenzuela was not present at the facility during today's visit.
An exit interview conducted, MA stated he understood the conditions of the Immediate Exclusion and would forward the letter and report to Executive Director Robert Barton.

A copy of this report along with the Immediate Exclusion letter was provided to the facility via email and a read receipt confirms receipt of the report.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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