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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 06/29/2025
Date Signed: 06/29/2025 01:39:14 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
05/05/2023 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 18-AS-20230505144042
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:
06/29/2025
UNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Community Business Director Teresa RamirezTIME COMPLETED:
01:43 PM
ALLEGATION(S):
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Staff did not provide authorized representative resident's records.
INVESTIGATION FINDINGS:
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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 requested the following documents for resident #1 (R1): face sheet, admission agreement dated:08/29/2019, physicians report dated:04/07/2021, Functional needs and service plan dated: 02/20/2021. On 06/28/25 from 8:45 am- 12pm LPA conducted Interviews with resident#2-11 (R2-R11), and between 1:00 pm and 3:30pm LPA conducted interviews with staff #1-8 (S1-S8).On 06/28/25 LPA conducted an tour of the facility. On 06/29/25 LPA conducted a review of R1’s file.

The investigation revealed the following:
It is being alleged that did not provide copies of resident and business file upon request.
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-20230505144042
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
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On 06/28/25 from 8:45 am- 12pm LPA conducted Interviews with R2-11 regarding the allegation above, 8 of 10 residents interviewed denied the allegation above and reported they have not requested copies of their records but believe they facility would provide them upon request. 2 of 10 residents interviewed denied the the allegation above and reported they have received copies of their records when requested. On 06/28/25 LPA unable to interview R1 as R1 passed away while receiving services outside of Atria Hacienda. On 06/28/25 from 1:00 pm - 3:30pm LPA conducted interviews with S1-S8 regarding the allegation above, 7 of 8 staff interviewed denied the allegation above, 1 of 8 staff interviewed reported having no knowledge of records request. 3 of 8 staff interviewed reported copies of records are provided in person when requested, 1 of 8 staff reported copies of records are provided as requested, 4 of 8 staff interviewed are unaware of how records are provided. On 06/29/25 LPA conducted a review of R1’s file, LPA did not observe any records request documentation.

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