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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336400075
Report Date: 12/07/2020
Date Signed: 12/07/2020 02:54:49 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 HACIENDAFACILITY NUMBER:
336400075
ADMINISTRATOR:BARTON, ROBERTFACILITY TYPE:
740
ADDRESS:44600 MONTEREY AVETELEPHONE:
(760) 341-0890
CITY:PALM DESERTSTATE: CAZIP CODE:
92260
CAPACITY:266CENSUS: 158DATE:
12/07/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Sarah Wolfe, Community Business DirectorTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Tricia Danielson contacted the facility via telephone to commence a case management visit via telephone due to COVID-19 and for precautionary measures. LPA identified herself and discussed the purpose of the call with Community Business Director - Sarah Wolfe. On 11/20/20, Community Care Licensing issued an Immediate Action Required letter to the Licensee regarding the employment of an individual named Alexander Burmudez. LPA was informed by the Community Business Director that Burmudez resigned from his position at the facility on 10/29/2020. The Community Business Director stated the facility did not wish to request an exemption for Burmudez and the action request was returned to the regional office on 12/1/2020. LPA has verified that the individual is not present, employed, or residing at the facility.

No deficiencies were cited during this visit. An exit interview was conducted with the Community Business Director via telephone and a copy of this report was provided via email. Verification of removal is complete.

SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 12/07/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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