336400075-7-2-2021-18-AS-NBRN-C8LPW7-20211109104012

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 06/25/2021
Date Signed: 07/02/2021 09:49:35 AM

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
06/02/2020 and conducted by Evaluator Pauline Beschorner

COMPLAINT CONTROL NUMBER: 18-AS-20200602112630

FACILITY NAME:	ATRIA HACIENDA		FACILITY NUMBER:	336400075
ADMINISTRATOR:	BARTON, ROBERT		FACILITY TYPE:	740
ADDRESS:	44600 MONTEREY AVE		TELEPHONE:	(760) 341-0890
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92260
CAPACITY:	266	CENSUS: 132	DATE:	06/25/2021
		UNANNOUNCED	TIME BEGAN:	12:12 PM
MET WITH:	Victoria Matas		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Due to neglect, resident was not cleaned and changed properly
Resident did not have required emergency call button
Staff failed to follow resident's doctor's orders

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pauline Beschorner conducted this investigation visit to conclude this agency’s investigation into the complaint allegations mentioned above. LPA spoke with Assistant Executive Director Victoria Mata.

During this investigation, interviews were conducted with the Executive Director, staff and independent witnesses. Resident 1’s (R1) Physician Report, Needs and Services Plan and other pertinent documentation was requested and reviewed. LPA was unable to interview R1.

The first allegation alleges due to neglect resident was not cleaned and changed properly. A review of facility records revealed that R1 was bathed twice a week and required minimal assistance. R1 did not require continence care. Interviews with staff revealed staff checked on R1 every 2 hours and would assist R1 with changing as needed. Interviews further revealed that during bathing, staff would assist with washing R1's hair

CONTINUED ON NEXT PAGE

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline Beschorner	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

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-20200602112630

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: ATRIA HACIENDA	FACILITY NUMBER: 336400075
	VISIT DATE: 06/25/2021

NARRATIVE

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but R1 would not allow staff to wash R1's body. A review of documentation provided revealed that assistance with washing R1’s body was needed however there was no documentation of bathing refusals submitted to LPA. Staff interviewed stated that R1 was a very clean person and never smelled of perspiration or appeared dirty.

The second allegation alleges resident did not have required emergency call button. Interviews with staff revealed that during the 2-hour checks the staff would ensure that the call button was within reach of R1. R1 always requested that the call button be placed to the right of R1's chair and on the nightstand to the right of R1's bed at night. S1, and S2 stated R1 misplaced the call button at times but staff would find it and place the call button back next to the chair or bed during the 2-hour checks. Staff interviews revealed R1 never used the call button and was very vocal about R1's needs and wants during the 2-hour checks. LPA was unable to corroborate that staff failed to provide the emergency call button.

The third allegation alleges staff failed to follow resident's doctor's orders. A review of facility records indicates that R1 was to wear compression socks in the AM and take off in the PM. Interviews with staff indicated that R1 would put the compression socks on but would later take them off as the socks were uncomfortable to wear. There were times when R1 refused to put the socks on but there is no documentation of refusals by facility staff. LPA was unable to corroborate that staff failed to follow R1's doctor's orders.

Although the above-mentioned allegations may have happened, or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore, the allegations are deemed UNSUBSTANTIATED at this time.

An exit interview was conducted, and a copy of this report was reviewed with and provided to Assistant Executive Director Victoria Mata, whose signature on this form confirm receipt of the above-mentioned documents.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline Beschorner	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 07/02/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2021

LIC9099 (FAS) - (06/04)

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