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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 02:10:22 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
08/24/2022 and conducted by Evaluator Wendy Gibbs
COMPLAINT CONTROL NUMBER: 18-AS-20220824173055
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:
08:05 AM
MET WITH:Stephanie RolandTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility is without an administrator
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:
On 09/01/2022, LPA Yolonda Delgado conducted and initial visit. During that visit, LPA Delgado received the following documents: UPS Mailing Label to Community Care Licensing (CCL), LIC200 (dated 05/11/2022) indicating administrator change, letter from LLC (dated 04/13/2022) approving the change, letter (dated 05/11/2022) informing CCL of Change of Administrator, LIC 501 Personnel Record (dated 04/14/2022), Administrator’s Resume, copy of Driver License, LIC 503 Health Screening (dated 01/11/2021), Administrator Certificate (effective 01/16/2022 expiration date 01/15/2024), LIC 508 Criminal Record Statement & out-of-State Disclosure (dated 04/14/2022), LIC308 Designation of Facility Responsibility (dated 04/14/2022), First Aid Training (certification date 04/15/2022 expiration date 04/15/2024), and Schedule updated (dated 4/13/2022).
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 2
Control Number 18-AS-20220824173055
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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During a subsequent visit conducted on 06/21/2025, LPA interviewed Staff S1-S5, interviewed Residents R1-R10, and received documents pertinent to the investigation. The following documents were received and reviewed an Administrator packet submitted on 06/06/2025 to Community Care Licensing (CCL).

The investigation revealed the following:


Allegation: Facility is without an Administrator
The allegation alleges that the former Administrator left in April 2022 and there has not been a replacement.

During the facility visit, LPA meet with the designated person listed on the Designation of Facility Responsibility (LIC308) while the current Administrator is on leave.

During record review, LPA received and reviewed the following documents for the Administrators who are filling in while the current Administrator is on leave. The documents include the following forms: Application For A Community Care Facility or Residential Care Facility for the Elderly License (LI200) dated 06/04/2025 indicating an administrator change, letter informing (CCL) of the change dated 06/04/2025, Personnel Record (dated 06/01/2025), Health Screening (LIC503) dated 05/30/2025, copy of California Driver License, Criminal Record Statement & Out-of-State Disclosure (LIC508) dated 05/30/2020, Department of Social Services Clearance Background Check, dated 02/23/2023, Administrator Certificate valid till 03/24/2027, Designation of Facility Responsibility (LIC308), resume, college transcripts, First Aid certificate valid till 11/19/2026, an updated LIC500, and a copy of the mailing slip for the package to be sent.

During interviews with Staff S1-S5, on 06/21/25 from 2:30PM to 4:15PM, were asked if the facility currently has an Administrator, five (5) out of five (5) stated yes, the facility has an administrator.

During interviews with Residents R1-R9, on 06/21/2025 from 10:20AM to 1:29PM, were asked if the facility currently has an Administrator, ten (10) out of ten (10) stated yes, the facility has an Administrator and S1 is covering for the Administrator while they are out.

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.

During today’s visit, 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)
Page: 2 of 2