<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336400075
Report Date: 09/16/2024
Date Signed: 09/17/2024 08:27:04 AM


Document Has Been Signed on 09/17/2024 08:27 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:ATRIA HACIENDAFACILITY NUMBER:
336400075
ADMINISTRATOR:ROBERT STANSBURYFACILITY TYPE:
740
ADDRESS:44600 MONTEREY AVETELEPHONE:
(760) 341-0890
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:266CENSUS: 168DATE:
09/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Executive Director Monique MoreriaTIME COMPLETED:
02:00 PM
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
On 9/16/24 Licensing Program Analyst's (LPAs) Valerie Flores and Abdoulaye Zerbo conducted an unannounced one (1) year required visit. LPA's were greeted by the Executive Director, Monique Moreria, who was informed of the purpose of visit. All staff present were observed to have obtained proper fingerprint clearance and were associated to the facility. LPA's observed the following during today's visit:

LPA's conducted a tour of the facility with Executive Director, Monique. The physical plant is a two-story structure that contains a total of 168 residents. While conducting the tour, LPA's observed all indoor and outdoor passageways were free of obstruction. The facility pool was gated and equipped with a self-latching door. The facility has more than a two (2) day supply of perishable foods and seven (7) day supply of non-perishable foods. Dishes and utensils were in sufficient supply and in good repair. Knives and sharp items are located in the locked kitchen areas making it inaccessible to the residents in care. There was a sufficient supply of emergency food and water to meet all resident needs. Water temperature measured at 113.5-degree Fahrenheit meeting within the required limits. Resident bedrooms had the required bedding, furniture, and lighting. LPA's observed charged fire extinguishers mounted throughout the facility. LPA's observed an outdoor courtyard with a shaded seating area and sufficient space to allow outdoor activities. The facility is maintained at 77 degrees-Fahrenheit for the resident’s comfort. There is a posted activity plan for the whole month of September to encourage resident interaction. The facility has a designated computer room that maintain computers connected to internet easily accessible to the residents in care. LPA reviewed the facility's infection control plan which met department requirements. There are several centrally stored medication rooms located throughout the facility. A sufficient amount of PPE was observed in the locked medication room.


(Continuation on LIC809C...)

SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie FloresTELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:
DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 09/16/2024
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
Staff files reviewed have a criminal record clearance/ exemptions, valid first aid/CPR certification, health screenings, TB results, employee rights, and required trainings. Resident files included but are not limited to signed admission agreements, pre-appraisals, appraisals, physicians reports, TB tests, and personal rights. Facility sketch, personal rights, LTCO and emergency disaster plan is posted on a wall near the theater. According to Administrator, Monique, there are no firearms or ammunition on the premises.

During today's visit, LPA's did not observe any immediate violations or concerns. An exit interview was conducted, and a copy of this report was reviewed and provided to the Administrator.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Valerie FloresTELEPHONE: (951) 248-0308
LICENSING EVALUATOR SIGNATURE:

DATE: 09/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2