336400075-7-14-2022-18-AS-DMUN-CGKVCC-20220722161855

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 07/14/2022
Date Signed: 07/14/2022 01:43:03 PM

Unsubstantiated

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
08/10/2020 and conducted by Evaluator Tricia Danielson

COMPLAINT CONTROL NUMBER: 18-AS-20200810154159

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: 81	DATE:	07/14/2022
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Asst. Business Office Manager Mariana Torres		TIME COMPLETED:	01:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Physical Abuse of a resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conclude a complaint investigation into the allegation noted above. LPA met with Assistant Business Manager Mariana Torres and explained the purpose of the visit. During the course of the investigation, the department obtained and reviewed copies of the following for Resident (R1): Physician’s Report, Physician’s Orders, Medication Administration Records (MARs), Death Report, Unusual Incident Reports, Admission Agreement, hospice records, the Functional Needs Care Service Plan and Profile, staff documented Resident Notes, and private duty caregiver documentation. The department also interviewed five (5) individuals which consisted of staff and witnesses. Regarding the allegation "physical abuse of a resident", it was alleged that (R1) was physically abused. R1 was observed to have bruises to the ankles, legs, and arms. Records reviewed revealed the bruises did not require medical attention and R1 did not express nor exhibit any discomfort as a result of the bruising. R1 also had bilateral extremity edema. Hospice records as well as the Functional Needs Care Service Plan and Profile indicated R1 required two (2) to three (3) staff to transfer R1 from one position to another and/or to provide care. (CONTINUED ON LIC 812C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

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 2

Control Number 18-AS-20200810154159

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: 07/14/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(CONTINUED FROM LIC 812)
Five (5) of five (5) individuals interviewed stated they had not abused R1 or observed anyone abusing R1, nor had they heard of anyone abusing R1. The investigation revealed the injuries may have occurred during transferring R1. R1 was unable to be interviewed.

The above allegation is found to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted with Assistant to the Business Office Manager Marianne Torres and a copy of this report along with LIC 811- Confidential Names list was provided.

SUPERVISOR'S NAME: Deborah Mullen	TELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia Danielson	TELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:	DATE: 07/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2