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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 06/22/2025
Date Signed: 06/22/2025 06:45:44 PM

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
10/30/2023 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20231030143610
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: 181DATE:
06/22/2025
UNANNOUNCEDTIME BEGAN:
08:03 AM
MET WITH:TIME COMPLETED:
02:35 PM
ALLEGATION(S):
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Staff are not assisting resident with their care needs.
INVESTIGATION FINDINGS:
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On June 22, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent visit to gather information regarding the above allegation. LPA met with Resident Service Director Stephanie Roldan, and explained the purpose of the visit. LPA was granted entry to the facility.

The investigation consisted of Interviews, a collection of records, and a tour of the facility. Interviews were conducted with staff members #1 to #4 (S1-S4) resident members #1 to #10 (R1-R10) and witness #1 (W1). List of documents reviewed/obtained Register of Facility Residents LIC 9020 (dated 06/11/25), Personne Report (dated 06/13/25), (R1)'s Physicians Report LIC 602 (dated 01/23/23), Residency Agreement (dated 01/18/23), Identification and Emergency Information LIC 601 (dated 05/02/23), Preplacement Appraisal Information LIC 603 (dated 01/29/23) and other records pertinent to this complaint.
(Evaluation Report continues LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2025
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-20231030143610
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: 06/22/2025
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff are not assisting resident with their care needs.

It is alleged that staff are not assisting Resident #1 (R1) with care needs. (R1) is visually impaired and struggles with making appointments and follow-ups for outpatient treatments. (R1) needs assistance but cannot afford this service. No further information is available on this matter.

A review of Resident #1's (R1) Residency Agreement (dated 01/18/23) shows that (R1) was admitted to Atria Hacienda on February 04, 2023. Additionally, an examination of the Identification and Emergency Information document (dated 05/02/23) reveals that a power of attorney is designated to manage financial matters, care payments, and legal affairs on behalf of (R1).

On November 06, 2023, between 09:45 AM and 11:58 AM, the Department interviewed a resident member identified as Resident #1 (R1). (R1) expressed concerns about challenges in making outpatient treatment appointments. (R1) mentioned that long call waits, scheduling issues, and staff shortages necessitated leaving messages. (R1) noted that a part-time private care staff member provides additional assistance with this task.

On June 21, 2025, between 11:45 AM and 12:15 PM, the Department conducted a supplemental interview with Resident #1 (R1). (R1) expressed that the staff is attentive and responsive and treats (R1) well. (R1) mentioned that (R1)'s Care Plan designates a Care Level 1, which includes escort services due to (R1)'s visual impairment. (R1) confirmed having a private care staff member who comes once a week for four hours to assist with tasks involving reading emails, shopping online, and scheduling appointments with health professionals. (R1) stated that (R1) prefers to remain independent and will make medical appointments with the primary care providers. (R1) can complete this duty using a Braille calendar. (R1) stated that although (R1) prefers to schedule appointments with health providers, the facility care staff will assist with this task if (R1) needs assistance.

On June 21, 2025, between 10:20 AM and 01:29 PM, the Department interviewed resident members identified as Resident #2 through Resident #10 (R2-R10). (R2-R10) resident members claimed to have no concerns or issues with their care needs.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20231030143610
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: 06/22/2025
NARRATIVE
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Seven (7) out of the nine (9) residents member claimed to handle their own health appointments. (R2-R10) stated that facility care staff could assist if needed with this task.

On November 06, 2023, and June 21, 2025, between 09:45 AM to 4:59 PM, the Department interviewed staff members identified as Staff #1 through Staff #5 (S1-S5). Five (5) out of the five (5) staff members could not corroborate this claim. (S1-S5) reported that (R1) is independent and did not need help with medical appointments, only requiring minimal assistance like escort services. (S1) stated that the care staff was unaware of (R1)’s situation and would have gladly assisted if they had known as they understood (R1)’s limitations.

On June 22, 2025, between 8:00 AM to 8:18 AM, the Department interviewed witness member identified as (R1)’s power of attorney as Witness #1 (W1). (W1) asserted that (R1) is independent, noting that (R1) is visually impaired, however can independently schedule health appointments. (W1) expressed confidence that the facility care staff provided adequate care and supervision with no concerns.

As a result of record reviews of (R1)’s Physician’s Report LIC 624A (dated 01/23/23), Preplacement Appraisal LIC 603 (dated 01/29/23), Resident Functional Needs Service Plan (dated 02/04/23) verified that (R1) requires only escort services and is self-care independently. (R1) did not need special medical attention or incidental health and medical care assistance. A further review of facility Personnel Report LIC 500 (dated 11/06/23 and 06/13/25) revealed no shortage of care staff for AM, PM, and NOC shifts to assist with resident’s care needs.

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

An exit interview conducted with Resident Service Director Stephanie Roldan and copies of the report provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3