336400075-4-26-2025-18-AS-RORN-DGAL5R-20250502082732

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 04/26/2025
Date Signed: 04/26/2025 04:32:50 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
07/17/2024 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20240717101852

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: 70	DATE:	04/26/2025
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Nathan Boese/Assistant Executive Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff are overcharging a resident for services not received.
Staff did not prevent the residents from wandering.
Staff did not keep the facility free from scabies.
Staff unlawfully evicted the residents.

INVESTIGATION FINDINGS:

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On 4/26/2025 at approximately 8:00 AM, LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. LPA Iniguez met with Nathan Boese/Assistant Executive Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Staff Interviews (S#1-S#4), Resident’s interviews (R#1-R#9). LPA obtained and reviewed the following documents: Resident Roster dated: 4/26/25, Staff Roster dated: 4/26/2025, (R#1 and R#2) Admissions Agreement dated: 9/21/22, (R#1 and R#2) Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated 9/19/22, (R#1)’ Unusual Incident Report or LIC 624 Dated: 6/18/24, staff in-service training regarding elopement of residents conducted on:4/14/25, and copies of facility infection control practices dated: September 2021.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: (707) 291-8399
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2025

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 6

Control Number 18-AS-20240717101852

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: 04/26/2025

NARRATIVE

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Investigation Revealed the Following:

Allegation: Staff are overcharging a resident for services not received.

The details of the complaint alleged that facility staff is overhanging (R#1 and R#2) for services not received.

On April 26, 2025, at approximately 2:00 PM, during a records review, LPA Iniguez observed that the admissions agreements for (R#1 and R#2), dated: September 21, 2022, included a clause under "Optional Services" stating, "We may also provide you with other Optional Services, if you request them, as described in Attachment F." This attachment outlines the optional services and associated fees. Additionally, LPA Iniguez noted that both (R#1 and R#2) had signed their admissions agreements on September 21, 2022. The LPA also reviewed the Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A, dated September 19, 2022. It indicated that the primary diagnosis for (R#1 and R#2) was not a factor influencing their decision-making. Furthermore, the report marked that they were neither confused nor disoriented, could follow instructions, and were able to communicate their needs.

On April 26, 2025, at approximately 8:30 AM, during an Interview with the Administrator (A#1), she stated that (R#1 and R#2) signed their own admissions agreement upon entering the facility back on September 21, 2022. Also, (A#1) stated that the facility never overcharged (R#1 and R#2) for services not provided by the facility when they were living in here.

On April 26, 2025, at approximately 10:00 AM, LPA Iniguez contacted former residents (R#1 and R#2) via telephone for the third time. They did not answer the call, so LPA Iniguez left a voice message.

On April 26, 2025, at approximately 10:00 AM, during interviews with residents (R#3-R#9), (7) out of (7) stated that they had not been overcharged by the facility for services not provided to them.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: (707) 291-8399
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 18-AS-20240717101852

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: 04/26/2025

NARRATIVE

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On April 26, 2025, at approximately 9:30 AM, during interviews with facility staff (S#1-S#4), (4) out of (4) stated that (R#1 and R#2) were not overcharged by the facility for services they did not receive.

Allegation: Staff did not prevent the residents from wandering.

The details of the complaint alleged that (R#1 and R#2) wandered out of the facility alone in the middle of the night.

On April 26, 2025, at approximately 2:00 PM, LPA Iniguez conducted a records review and examined the Physicians Report for Residential Care Facilities for the Elderly (RCFE), known as LIC 602A, dated September 19, 2022. The report indicated that Residents #1 (R#1) and #2 (R#2) were neither confused nor disoriented, could follow instructions, and could communicate their needs. Additionally, it was noted that both residents were able to leave the facility unassisted. During the review, LPA Iniguez also looked at (R#1)’s Unusual Incident Report, which was dated June 18, 2024. The report stated that (R#1) was observed by facility staff outside the community at approximately 6:00 AM searching for (R#2). Staff promptly redirected (R#1) back inside, and an incident report was created with the appropriate parties notified. Moreover, LPA Iniguez reviewed facility staff training materials regarding elopement of residents, lates staff training was conducted on 4/14/25.

On April 26, 2025, at approximately 8:30 AM, during an Interview with the Administrator (A#1), she stated that neither (R#1 or R#2) wandered out by themselves in the middle of the night. Just the one incident when (R#1) was observed in front of the community looking for (R#2) at approximately 6:00 AM. Staff promptly re-directed them inside and documented this event on an LIC 624.

On April 26, 2025, at approximately 10:00 AM, LPA Iniguez contacted former residents (R#1 and R#2) via telephone for the third time. They did not answer the call, so LPA Iniguez left a voice message.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: (707) 291-8399
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 6

Control Number 18-AS-20240717101852

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: 04/26/2025

NARRATIVE

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On April 26, 2025, at approximately 10:00 AM, during interviews with residents (R#1-R#7), (7) out of (7) stated that they feel the facility staff will handle an elopement of a resident in care.

On April 26, 2025, at approximately 9:30 AM, during interviews with facility staff (S#1-S#4), (4) out of (4) stated that (R#1) did not wander out of the facility in the middle of the night, both stated that (R#1) was observed one time in front of the community but was promptly re-directed by facility staff.

Allegation: Staff did not keep the facility free from scabies.

The details of the complaint alleged that (R#1 and R#2) contracted scabies while at the facility.

On April 26, 2025, at approximately 02:00 PM, during the records review, LPA Iniguez reviewed (R#1) and (R#2) entire files, LPA Iniguez did not observe medical records regarding (R#1 and R#2) had contracted scabies during their stay at the facility. In addition, LPA Iniguez observed the facility's infection control plan dated September 2021; it is stated that the facility has a plan in case of an infectious disease or outbreak.

On April 26, 2025, at approximately 8:30 AM, during an Interview with the Administrator (A#1), she stated that (R#1 and R#2) did not contract scabies while they resided at the facility.

On April 26, 2025, at approximately 10:00 AM, LPA Iniguez contacted former residents (R#1 and R#2) via telephone for the third time. They did not answer the call, so LPA Iniguez left a voice message.

On April 26, 2025, at approximately 10:00 AM, during interviews with residents (R#1-R#7), (7) out of (7) stated that they had never contracted scabies at the facility.

On April 26, 2025, at approximately 9:30 AM, during interviews with facility staff (S#1-S#4), (4) out of (4) stated that (R#1 and R#2) never contracted scabies while they resided at the facility.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: (707) 291-8399
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 18-AS-20240717101852

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: 04/26/2025

NARRATIVE

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Allegation: Staff unlawfully evicted the residents.

The detail of the complaint alleges that facility staff gave an illegal eviction to (R#1 and R#2).

On April 26, 2025, at approximately 2:00 PM, LPA Iniguez reviewed the records for (R#1 and R#2). During the review, LPA Iniguez found no eviction notices served to either (R#1 or R#2). Additionally, LPA Iniguez examined the Admissions Agreement contracts for both (R#1 and R#2), which were dated September 21, 2022. It was explained that a 30-day or 3-day notice may be issued if any written reasons outlined in the agreement apply to (R#1 or R#2).

On April 26, 2025, at approximately 8:30 AM, during an Interview with the Administrator (A#1), she stated that the facility never gave an illegal eviction notice to (R#1 or R#2).

On April 26, 2025, at approximately 10:00 AM, LPA Iniguez contacted former residents (R#1 and R#2) via telephone for the third time. They did not answer the call, so LPA Iniguez left a voice message.

On April 26, 2025, at approximately 10:00 AM, during interviews with residents (R#1-R#7), (7) out of (7) stated that they had never received an illegal eviction notice from the facility.

On April 26, 2025, at approximately 9:30 AM, during interviews with facility staff (S#1-S#4), (4) out of (4) stated that (R#1 and R#2) did not receive an illegal eviction notice from the facility.

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

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: (707) 291-8399
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2025

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 18-AS-20240717101852

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: 04/26/2025

NARRATIVE

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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 Nathan Boese/Assistant Executive Director.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: (707) 291-8399
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2025

LIC9099 (FAS) - (06/04)

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