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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 04/27/2025
Date Signed: 04/27/2025 10:33:31 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
06/08/2023 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230608142049
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: 70DATE:
04/27/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Stephanie Roldan/Resident Services DirectorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Resident is being held at the facility against their will
INVESTIGATION FINDINGS:
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On 4/27/2025 at approximately 8:00 AM, LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Stephanie Roldan/Resident Services Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Staff Interviews (S#1-S#4), Resident’s interviews (R#1-R#8) and Witnesses Interviews (W#1). LPA obtained and reviewed the following documents: Resident Roster dated:4/26/25, Staff Roster dated:4/26/25, (R#1)’s Admissions Agreement dated:2/28/23, (R#1)’s Identification and Emergency Information or LIC 601 dated:2/28/23, (R#1)’s Facility face sheet printed:4/22/25 and copy of (R#1)’s General Durable Power of Attorney dated:6/6/2014.

Evaluation Report continues LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2025
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 3
Control Number 18-AS-20230608142049
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ATRIA HACIENDA
FACILITY NUMBER: 336400075
VISIT DATE: 04/27/2025
NARRATIVE
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Investigation Revealed the Following:

Allegation: Resident is being held at the facility against their will.

The details of the complaint alleged that (R#1) was held against their will at the facility.



On April 27, 2025, at approximately 8:30 AM, during a records review, LPA Iniguez observed a copy of (R#1)'s Durable Power of Attorney, which was dated and sealed on June 6, 2014. The document listed (W#1) as the decision-maker for (R#1). Additionally, LPA Iniguez reviewed (R#1)’s Identification and Emergency Information form or LIC 601, dated February 28, 2023. This form identified (W#1) as the person responsible for (R#1)'s financial affairs, payment for care, and as (R#1)'s legal guardian. Furthermore, LPA Iniguez noted that (R#1)’s facility face sheet, printed on April 22, 2025, indicated that (R#1) has a Durable Power of Attorney on file, with (W#1) listed as the responsible party. LPA Iniguez also reviewed (R#1)’s Admissions Agreement, which was dated February 28, 2023, and noted that (W#1) signed this document on behalf of (R#1).

On April 26, 2025, at approximately 8:30 AM, during an interview with the Administrator (A#1), she stated that when (R#1) moved into the facility, they had a Durable Power of Attorney designating (W#1) as their decision-maker. Additionally, (A#1) mentioned that (R#1) was not admitted under false pretenses and was not held against their will while residing at the facility.

On April 24, 2025, at approximately 3:00 PM, Licensing Program Analyst-LPA Alfonso Iniguez could not speak with (R#1) due to their cognitive impairment.

On April 26, 2025, at approximately 10:00 AM, during interviews with residents (R#2-R#8), (7) out of (7) stated that they are not being held against their will and feel safe living here at the facility.

Evaluation Report continues LIC 9099-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20230608142049
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ATRIA HACIENDA
FACILITY NUMBER: 336400075
VISIT DATE: 04/27/2025
NARRATIVE
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On April 26, 2025, at approximately 9:00 AM, during interviews with facility staff (S#1-S#4), (4) out of (4) stated that that when (R#1) moved into the facility, they had a Durable Power of Attorney designating (W#1) as their decision-maker. Additionally, (4) out of (4) facility staff mentioned that (R#1) was not admitted under false pretenses and was not held against their will while residing at the facility.

On April 24, 2025, at approximately 8:30 AM, Licensing Program Analyst Alfonso Iniguez spoke via telephone with (W#1), who resides out of state. LPA Iniguez introduced himself and explained that he was calling to ask questions regarding the complaint allegation related to (R#1). He inquired whether (R#1) had been placed at the facility against their will. (W#1) responded, “No, they were not” confirming that (R#1) was not placed at the facility against their will or under false pretenses. (W#1) explained that the decision to place (R#1) in the facility was made because they were unable to meet (R#1)'s medical needs. Furthermore, (W#1) indicated that they held Durable Power of Attorney for both healthcare and financial decisions for (R#1).


During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

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 the Complaint Report was given to Stephanie Roldan/Resident Services Director.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3