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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 06/20/2023
Date Signed: 06/20/2023 03:00:23 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
06/15/2023 and conducted by Evaluator Yolanda Delgado
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20230615152721
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: 165DATE:
06/20/2023
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Robert Stansbury, Sr. Executive DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Unlawful eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Yolanda Delgado arrived at the facility to conclude a complaint investigation into the allegation listed above. LPA identified herself and discussed the purpose of the visit and the elements of the investigation with Sr. Executive Director (ED) Robert Stansbury. Regarding the allegation "unlawful eviction", it was alleged that Resident #1 (R1) was served an unlawful eviction order from the facility. Records reviewed during the investigation revealed that R1 and/or R1's responsible party signed an admission agreement containing the Change in Level of Care at the facility on 10/25/2022. R1's and/or R1's responsible party was informed of the changes in Level of care on the Functional Needs Assessments that were done on 11/29/2022, 1/25/2023. 2/25/2023, 4/18/2023 and 5/25/2023.
(CONTINUED ON LIC9099-C PAGE 2)
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
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-20230615152721
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 HACIENDA
FACILITY NUMBER: 336400075
VISIT DATE: 06/20/2023
NARRATIVE
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(CONTINUED FROM LIC9099 PAGE 1)

Facility staff reviewed the assessments on each date mentioned with R1 however R1 did not sign the assessments at the discretion of the POA (for medical only) advice. R1’s inability to self-manage personal needs and resident expectations which must be followed to reside at the facility. Facility documentation reviewed and interviews revealed R1 and R2 is aware of the changes in Level of Care that R1 needs. This agency has investigated the complaint alleging "unlawful eviction". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided along with LIC 811- Confidential Names list.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Yolanda Delgado
LICENSING EVALUATOR SIGNATURE:

DATE: 06/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2