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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336400075
Report Date: 10/18/2021
Date Signed: 10/18/2021 11:57:17 AM

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: 154DATE:
10/18/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Robert Barton, Executive DirectorTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Amy Goldenberg is conducting this case management visit in regard to complaint investigation control number 18-AS-20200602112630. The purpose of this visit is to address possible additional information regarding the complaint investigation. During this visit LPA met with Executive Director Robert Barton. LPA and Mr. Barton further discussed hygiene assistance and documentation procedures. LPA was provided with facility census, R1's resident Functional Needs and Service Plan dated 04/29/2020, a sample of R1's resident monthly completed task for 04/29/2021, and resident notes for R1.

Based on further record review and interview with Executive Director Robert Barton, LPA has found that the review of the information will not change the outcome of the delivered findings of the investigation for control number 18-AS-20200602112630.

This report was reviewed with and a copy was provided to the facility representative.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 248-0339
LICENSING EVALUATOR NAME: Amy GoldenbergTELEPHONE: (951) 248-0351
LICENSING EVALUATOR SIGNATURE:

DATE: 10/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021
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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