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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 05/12/2023
Date Signed: 05/12/2023 03:22:34 PM

Unfounded


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
04/18/2023 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230418075815
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: 157DATE:
05/12/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Robert Stansbury, Executive DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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9
Facility staff did not notify resident's responsible party of a change in resident's condition
Resident is being illegally evicted
Facility staff is not following resident's authorized care plan
Facility staff bullied resident
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Tricia Danielson and Janette Romero arrived unannounced to the facility to conclude an investigation into the allegations listed above. LPAs met with Assistant Executive Director April Princessa and explained the purpose of the visit. Executive Director Robert Stansbury arrived a short time later.
Regarding the allegation "Facility staff did not notify resident's responsible party of a change in resident's condition", it was alleged that Resident #1's (R1's) responsible party was not provided notification that R1 had a change in their condition following admission. Review of R1's admission agreement dated 10/18/2022 revealed R1 is responsible for themselves. R1's admitting Physician's report dated 10/25/2022 revealed R1 was not confused or disoriented, able to follow directions, able to communicate their needs, able to manage their own cash resources, and did not have a diagnosis of dementia or any cognitive impairment. Review of R1's Durable Power of Attorney (DPOA) for Financial Management dated 12/10/2022 revealed R1 has granted a close family member the power to manage, dispose of, sell, and convey their real and personal property, and to use their personal property as security if the DPOA borrows money on behalf of R1. The DPOA specifically indicates that the DPOA does not authorize (CONTINUED ON LIC9099-C)
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 782-4807
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
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-20230418075815
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: 05/12/2023
NARRATIVE
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(CONTINUED FROM LIC9099)
anyone to make medical or other health care decisions for R1. Interviews conducted with facility staff and R1 revealed staff discussed R1's change in condition directly with R1.
Regarding the allegation "Resident is being illegally evicted", it was alleged that R1 had back charges that had been paid but was still served with eviction notices. Review of R1's facility file did not yield any evidence that an eviction notice was served to R1. During interview with R1, R1 denied receiving an eviction notice.
Regarding the allegation "Facility staff is not following resident's authorized care plan", it was alleged that R1 had a change in condition which resulted in a higher level of plan of care which was not authorized by R1's Power of Attorney. Review of R1's file including their admission agreement dated 10/18/2022 revealed R1 is responsible for themselves. R1's admitting Physician's report dated 10/25/2022 revealed R1 was not confused or disoriented, able to follow directions, able to communicate their needs, able to manage their own cash resources, and did not have a diagnosis of dementia or any cognitive impairment. Review of R1's Durable Power of Attorney (DPOA) for Financial Management dated 12/10/2022 revealed R1 has granted a close family member the power to manage, dispose of, sell, and convey their real and personal property, and to use their personal property as security if the DPOA borrows money on behalf of R1. The DPOA specifically indicates that the DPOA does not authorize anyone to make medical or other health care decisions for R1.
Regarding the allegation "Facility staff bullied resident", it was alleged that R1 did not sign their own Functional Needs Service Plan at level 6 and facility staff bullied R1 into believing they did so. Interview with R1 revealed they did sign the level 6 plan and denied being or feeling bullied in doing so. Records with R1's signature including DPOA, admission agreement, and previous Functional Needs Service Plans revealed similar signatures. A signature provided to LPA and facility staff by R1 was also similarly consistent as well.
This agency has investigated the complaint alleging "Facility staff did not notify resident's responsible party of a change in resident's condition", "Resident is being illegally evicted", Facility staff is not following resident's authorized care plan", and "Facility staff bullied resident". We have found that the allegations were unfounded, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. An exit interview was conducted and a copy of this report was provided along with LIC811- Confidential Names list.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 782-4807
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 3
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
04/18/2023 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230418075815

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: 157DATE:
05/12/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Robert Stansbury, Executive DirectorTIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff do not respond to resident's calls for assistance in a timely manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Tricia Danielson and Janette Romero arrived unannounced to the facility to conclude an investigation into the allegations listed above. LPAs met with Assistant Executive Director April Princessa and explained the purpose of the visit. Executive Director Robert Stansbury arrived a short time later.
Regarding the allegation "Facility staff do not respond to resident's calls for assistance in a timely manner", it was alleged that the facility is very short handed which results in typically an hour or more response after resident's call buttons are pressed. Interviews were conducted with twelve (12) residents and all twelve (12) residents did not report any concerns related to staff response times to call buttons. All twelve (12) residents interviewed also reported they enjoyed living at the facility.
Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 782-4807
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3