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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 05/10/2022
Date Signed: 05/10/2022 11:18:13 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/15/2020 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20201215161011
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: 148DATE:
05/10/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Community Business Director Sarah WolfeTIME COMPLETED:
11:25 AM
ALLEGATION(S):
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Facility neglected resident by not seeking medical attention in a timely manner
Facility did not follow resident's care plan.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tricia Danielson arrived unannounced to the facility to conclude an investigation into the allegations listed above. LPA met with Community Business Director Sarah Wolfe and explained the purpose of the visit. Regarding the allegation "Facility neglected resident by not seeking medical attention in a timely manner", it was alleged that Resident #1 (R1) experienced a fall at the facility on July 18, 2020 but was not sent out to the hospital for evaluation until July 19, 2020. The investigation revealed on July 18, 2020, R1 was found on the floor in the entry way of their room after R1 activated their alert button. Interviews conducted revealed initial discussions with R1's family and facility staff resulted in R1 not being sent to the hospital. R1's family requested that R1 not be sent and the facility complied. Interviews conducted with R1's hospice provider revealed that after the hospice provider spoke to R1's family on July 18, 2020, the family then agreed to have R1 sent to the hospital. However, review of hospital records revealed R1 was not sent out to the hospital until the following morning in July 19, 2020 and was subsequently hospitalized for a hip fracture resulting in surgery. Regarding the allegation “Facility did not follow resident’s care plan”, it was alleged that the facility neglected to escort R1 back to their room following their return from a visit as required (CONTINUED ON LIC 9099C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
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-20201215161011
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ATRIA HACIENDA
FACILITY NUMBER: 336400075
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
05/11/2022
Section Cited
CCR
87465(g)
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Incidental Medical and Dental Care- (g) The licensee shall immediately telephone 9-1-1 if an injury...has resulted in an imminent threat to a resident’s health...except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met as evidenced by:
The licensee did not ensure 9-1-1 was called immediately following R1's fall on
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The facility states they will submit a written statement of understanding of the regulation cited as well as conduct training with all staff regarding the regulation cited by POC due date of 5/11/2022. LPA will allow time for training to be completed.
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 7/18/2020. Based on interviews conducted and records reviewed, R1 was not sent for medical evaluation of their fall until 7/19/2020. The fall resulted in a hip fracture. which required surgery. This poses an immediate health, safety, and personal rights risk to residents in care.
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Request Denied
Type A
05/11/2022
Section Cited
CCR
87464(f)(1)
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Basic Services- (f)Basic services shall at a minimum include: (1)Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).
This requirement was not met as evidenced by:
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The facility states they will submit a written statement of understanding of the regulation cited as well as conduct training with all staff regarding the regulation cited by POC due date of 5/11/2022. LPA will allow time for training to be completed.
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The licensee did not ensure R1 was provided proper care and supervision during their ambulation following a visit. Based on interviews conducted and records reviewed, R1's care plan required the provision of escorting services which were not provided. This poses a immediate health, safety, and personal rights risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 18-AS-20201215161011
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ATRIA HACIENDA
FACILITY NUMBER: 336400075
VISIT DATE: 05/10/2022
NARRATIVE
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(CONTINUED FROM LIC 9099C)
per their care plan which resulted in R1 falling and suffering a hip fracture. The investigation revealed on July 18, 2020, R1 was dropped off at the front entry area of the facility following an outing with family as observed by Staff #1 (S1). Interview with S1 revealed S1 observed R1 ambulating utilizing their walker and S1 noted no concerns. S1 stated they inquired with R1 if assistance was needed in getting back to their room, to which R1 replied, “No” and continued ambulating to their room. S1 later heard via facility radio that R1 had fallen in front of their room. Records reviewed revealed R1’s care plan listed escorting services which had been specifically requested by R1’s family. Interviews revealed, R1’s family was previously providing the escort back to R1’s room, however due to the facility’s change in process, R1’s family was no longer permitted to escort R1 when R1 was returned to the facility after being out with family.
Based on LPAs observations, interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations have been found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC 9099 D. An exit interview was conducted and a copy of this report was provided along with LIC 811- Confidential Names List and Appeal Rights were provided.
SUPERVISOR'S NAME: Deborah MullenTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3