336400075-6-22-2025-18-AS-RORN-DHZSPL-20250626140318

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 06/22/2025
Date Signed: 06/22/2025 02:31:38 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
10/04/2021 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 18-AS-20211004100309

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: 181	DATE:	06/22/2025
		UNANNOUNCED	TIME BEGAN:	08:03 AM
MET WITH:	Stephanie Roldan		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Staff not providing adequate services.
Facility in disrepair.

INVESTIGATION FINDINGS:

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On 06/22/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced subsequent Complaint Visit to the facility listed above. LPA met with Resident Service Director, Stephanie Roldan, and the purpose of today’s visit was explained. LPA was granted entry into the facility.

The investigation consisted of the following:
During the initial visit, conducted on 10/21/2021 by LPA Yolonda Delgado, received the following documents: resident Face Sheet, Visitor Logs for 10/03/2021, and Time Detail logs for 10/03/2021.
During a subsequent visit conducted on 06/21/2025, LPA Gibbs, received and reviewed the following documents: resident Admission Agreement, resident Physician’s Report dated 9/21/21, Pre-Placement Appraisal Information dated 09/25/21 , and Service Plans (dated 09/28/2021, 11/02/2021, 06/22/2022, and 05/27/2023).

During today’s visit LPA Gibbs, received and reviewed Care Staff Training Logs and Work Order.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
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-20211004100309

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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The investigation revealed the following:

Allegation: Staff not providing adequate services

The allegation alleges that there is not enough staff to provide adequate services to residents.

During the facility tour, LPA observed four (4) caregivers and a Medication Technician (Med Tech) in the Memory Care Unit. LPA observed caregivers providing assistance to residents, a caregiver in common areas interacting with residents and supervising residents, and the Med Tech was passing afternoon medications.

During record review at the facility, LPA reviewed the Time Detail Logs for 10/03/2021, on the AM shift there were seven (7) caregivers and four (4) Med Techs, on the PM shift there were six (6) caregivers and three (3) med techs, and on the NOC shift there were four (4) caregivers and two (2) med techs. LPA reviewed Staff Training Logs and observed staff receive training regarding Assisting With Activities of Daily Living (ADLs). Additionally, LPA received and reviewed Resident R1’s Service Plan dated 09/28/2021 that states R1 requires stand-by-assistance with all grooming two (2) times a day, complete assistance with dressing two (2) times a day, and complete assistance with showering and bathing two (2) times weekly, and assistance with toileting and incontinence six (6) times per day.
During interviews with Staff S1-S5, on 06/21/25 from 2:30PM to 4:15PM, were asked if there is enough staff on each shift to meet resident needs, four (4) out of five (5) stated there is enough staff to meet resident needs.
During interview with Resident R1 on 10/12/2021 and additional interviews with Residents R2-R10, on 06/21/25 from 10:20AM to 1:29PM, were asked if staff meet their care needs, ten (10) out of ten (10) stated their care needs are met.

During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Allegation: Facility in disrepair.

The allegation alleges that the facility is in disrepair.
During the facility tour, LPA observed the facility to be clean and in good repair.
During record review, LPA reviewed Work Orders that have been submitted and completed from 05/01/2025 to 06/22/2025.
During interviews with Staff S1-S5, on 06/21/25 from 2:30PM to 4:15PM, were asked if there is anything not working properly or not working in the facility, five (5) out of five (5) stated everything is working properly in

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
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-20211004100309

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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the facility. Additionally, Staff S1-S5, were asked if the facility is in disrepair, five (5) out of five (5) stated the facility is not in disrepair.
Staff S1 and S5, during interviews were asked how long a repair takes once a Work Order has been put in, two (2) out of two (2) stated repairs are made within 24-hours unless a part is ordered and then will take at the most 72-hours for the repairs to be made. Additionally, Staff S1 and S2 stated if the repair cost is estimated $1000 or above, the repair must be approved by corporate before the repair is done.
During interviews with Residents R2-R10, on 06/21/25 from 10:20AM to 1:29PM, were asked if there is anything in their rooms not working properly, eight (8) out of nine (9) stated everything is working properly in their room. Additionally, Residents R2-R10 were asked if the facility was in disrepair, nine (9) out of nine (9) stated the facility is not in disrepair.

LPA did not observe or cite any deficiencies.

An exit interview was conducted with Resident Service Director, Stephanie Roldan, and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
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)

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