336400075-7-13-2025-18-AS-EMAZ-DKPRE9-20250819125711

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 07/13/2025
Date Signed: 07/13/2025 12:46:43 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
12/22/2023 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20231222144402

FACILITY NAME:	ATRIA HACIENDA		FACILITY NUMBER:	336400075
ADMINISTRATOR:	ROBERT STANSBURY		FACILITY TYPE:	740
ADDRESS:	44600 MONTEREY AVE		TELEPHONE:	(760) 341-0890
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92260
CAPACITY:	266	CENSUS: 90	DATE:	07/13/2025
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Theresa Ramirez/Business Office Manager		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Resident sustained unexplained bruises while in care

INVESTIGATION FINDINGS:

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On 7/13/2025, LPA Alfonso Iniguez conducted a subsequent unannounced complaint visit. LPA Iniguez met with Theresa Ramirez/Business Office Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of the following: the Department conducted the following interviews: Assistant Executive Director (PA#1), Facility Staff (PS#1), Resident Interview (PR#1), Witnesses Interviews (PW#1-PW#3), and Former Facility Staff (PS#2). The Department obtained and reviewed the following documents: Copy of SOC 341 dated:12/22/2023 and copy of Riverside County Sheriff's Department Incident Report dated:12/23/2023, copy of Investigations Branch Service Request dated 12/26/23, copy of Report of Suspected Dependent Adult/Elder Abuse dated:12/22/23.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20231222144402

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: 07/13/2025

NARRATIVE

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Investigation Revealed the Following:

Allegation: Resident sustained unexplained bruises while in care.

The details of the complaint alleged that (PR#1) sustained unexplained bruises.

On 7/13/25, at approximately 8:00 AM, during the records review, the department observed a copy of the Riverside County Sheriff's Department Incident Report dated:12/23/2023. In the report, it is written that a deputy was dispatched to an elder abuse call at the facility. The deputy spoke with (PR#1), who stated that they did not recall how they sustained their injury. Additionally, (PR#1) immediately stated that nobody did that to them, "it could have done it to myself while I was asleep, I do not recall how the injury occurred".

On 1/19/24, during an interview with resident 1 (PR#1), they stated that they did not know how the injury might have happened; they assumed that while they were asleep, one of their hand rings might have been the cause. Additionally, (PR#1) stated that neither the facility staff nor the agency caregivers had assaulted them, (PR#1) said "I would have known if those things had happened to me".

On 2/9/24, during an interview with witness 1 (PW#1), they stated that (PR#1) never called them to inform them that someone at the facility had assaulted them. Additionally, the department asked (PW#1) if they believed (PR#1) was in any danger residing at the facility, (PW#1) stated “no”. Also, the department asked (PW#1) if they felt anyone at the facility physically assaulted (PR#1), causing their injury; (PW#1) stated they did not.

On 2/14/24, during an interview with witness 2 (PW#2), they stated that they saw (PR#1)’s injury and asked them what happened. (PR#1) stated that they did not know what happened. Also, (PR#1) stated that they did not fall, nor did anyone assault them. Additionally, (PW#2) stated that they believe (PR#1) was “very smart”; they feel that (PR#1) would remember if something happened to them.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 18-AS-20231222144402

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: 07/13/2025

NARRATIVE

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On 3/6/24, during an interview with witness 3 (PW#3), they stated that (PR#1) explained to them that they just woke up that morning, and they had a mark under their eye. (PW#3) stated that they asked (PR#1) if anyone had struck them; they said no one had struck them. Also, (PW#3) asked (PR#1) if they felt, and they said no. Additionally, (PW#3) stated that they suspected (PR#1) quite possibly rolled over onto something in their sleep, or invertedly hit their face on something in the middle of the night.

On 1/19/24, during an interview with Assistant Executive Director (PA#1), they stated that the facility staff informed them about (PR#1)’s injury, and they had observed their injury. Additionally, (PA#1) stated that they asked (PR#1) what happened, and they just replied that they had a little injury and did not know how they sustained it.

On 1/19/24 and 3/13/24, during interviews with staff members 1 and 2 (PS#1 and PS#2), they reported noticing (PR#1)’s injury and inquired about the incident. (PR#1) stated that they could not recall what had happened.

During this investigation, LPA did not find sufficient evident to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of the Complaint Report was given to Theresa Ramirez/Business Office Director.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2025

LIC9099 (FAS) - (06/04)

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