336400075-6-29-2025-18-AS-JHAD-DKQ32J-20250819175200

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 06/29/2025
Date Signed: 06/29/2025 01:40:04 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
03/14/2023 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 18-AS-20230314121417

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:	06/29/2025
		UNANNOUNCED	TIME BEGAN:	08:08 AM
MET WITH:	Community Business Director Teresa Ramirez		TIME COMPLETED:	01:42 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff member forged resident's signature.

INVESTIGATION FINDINGS:

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

On 06/29/25 Licensing Program Analyst (LPA) Villegas conducted a subsequent visit to deliver complaint findings. LPA met with Community Business Director Teresa Ramirez as the purpose of today’s visit was explained.

The investigation consisted of the following: On 06/28/25 LPA Villegas obtained copies of the staff and resident roster and obtained the following documents for resident #1 (R1): face sheet, admission agreement dated:10/25/2022, Preplacement appraisal info:10/16/2022, physicians report dated:12/29/2022, needs and service plan dated:5/25/23, 4/15/23, 2/25/23, 1/25/23, 11/29/22, 11/1/22,10/16/2022. On 06/28/25 LPA obtained copies of the following for staff #1(S1): ID, resume, fingerprint clearance dated: 11/30/22, LIC 503 dated: 11/28/22, LIC 508 dated: 12.19/22, position description dated: 11/28/22, new hire training confirmation dated: 12/19/22, corrective action form 8/3/23, 8/8/23, 7/26/23, 4/27/23, 4/26/23, termination checklist dated: 8/8/23. On 06/28/25 from 8:45 am- 12pm LPA conducted Interviews with resident#2-11(R2-R11),

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2025

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-20230314121417

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: 06/29/2025

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

and between 1pm and 3:30pm LPA conducted interviews with staff #2-9 (S2-S9). On 06/29/25 LPA conducted a review of R1’s and S1’s file.

The investigation revealed the following:

Allegation: Facility staff member functional forged residents’ signature.

It is being alleged that facility staff forged residents’ signature for the facility to bill for a higher level of care. On 06/28/25 from 8:45 am- 12pm LPA conducted Interviews with R#2-11 regarding the allegation above, 10 of 10 residents denied the allegation above and reported feeling safe and comfortable when assisted by facility staff. On 06/28/25 between 1pm and 3:30pm LPA conducted interviews with S#2-9 regarding the allegation above, 8 of 8 staff interviewed denied the allegation above. On 06/28/25 LPA unable to interview S1 as S1 is no longer employed at Atria Hacienda. On 06/28/25 LPA unable to interview R1 as R1 passed away while receiving care outside of Atria Hacienda. On 06/27/25 LPA conducted telephone interview with Witness #1 (W1) regarding the allegation above, Per W1 an assessment was conducted on R1 on 11/30/22, the assessment resulted in a change from level 1 care to level 6 care which is a difference of $4500 in care charges. W1 continued to report that the signature on the assessment agreeing to the additional care fees is not R1’s signature. On 06/29/25 LPA conducted a review of R1’s file, LPA observed 7 service plan assessment conducted on 5/25/23, 4/15/23, 2/25/23, 1/25/23, 11/29/22, 11/1/22,10/16/2022. Per assessment conducted on 11/29/22, R1 level of care was a 3, LPA did not observe any signatures on the assessment document. Per assessment dated 11/29/22 it is indicated facility staff would coordinate with resident and family to assure that services are in place to maintain safety for resident while in care. Additionally, during file review LPA did not observe any documentation indicating that R1 had a conservator nor power of attorney. Per R1’s file R1 was self responsible. On 06/29/25 LPA conducted a review of S1’s file, LPA did not observe any corrective action documentation linked to the allegation above.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 2