336400075-6-18-2021-18-AS-NBRN-C48TNN-20210622145302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336400075
Report Date: 06/18/2021
Date Signed: 06/18/2021 03:30:20 PM

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
06/11/2021 and conducted by Evaluator Shaunte Henry

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210611125612

FACILITY NAME:	ATRIA HACIENDA		FACILITY NUMBER:	336400075
ADMINISTRATOR:	BARTON, ROBERT		FACILITY TYPE:	740
ADDRESS:	44600 MONTEREY AVE		TELEPHONE:	(760) 341-0890
CITY:	PALM DESERT	STATE: CA	ZIP CODE:	92260
CAPACITY:	266	CENSUS: 140	DATE:	06/18/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Manny Salazar, Resident Services Coordinator and Theresa Ramirez, Activities Director		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility staff is psychologically abusing residents.
Facility staff is not administering medications as ordered by physician.
Facility staff is not assisting residents with ADLs.

INVESTIGATION FINDINGS:

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On 6/18/21 Licensing Program Analyst (LPA) Shaunte Henry conducted an unannounced visit for the purpose of investigating the above allegations. LPA met with Manny Salazar and Theresa Ramirez, explained the nature of the visit and was granted entry into the facility.

The investigation, which included document review and interviews revealed the following:
Allegation #1: Facility staff is psychologically abusing residents. Interviews with staff revealed that Resident 1 (R1) is verbally and physically abusive to staff. Incidents have been documented and provided to Community Care Licensing (CCL).

Allegation #2: Facility staff is not administering medications as ordered by physicians.
Interviews revealed that R1 will report not receiving medication even after the medication has been administered. LPA observed R1's medication administration record (MAR) and it indicates that R1 is receiving medication as ordered by the physician.
***Continued on 9099C***

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021

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-20210611125612

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: 06/18/2021

NARRATIVE

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***Continued from 9099**

Allegation #3: Facility staff is not assisting residents with ADLs.
Interviews and documentation review revealed that R1 is independent and does not require assistance with ADLs. R1's admission agreement indicates medication management and not assistance with ADLs.

This agency has investigated the complaint allegation. 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 where the 9099, 9099C and LIC 811 were provided to Manny Salazar , Theresa Ramirez and Cheree Escandel via email.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Shaunte Henry	TELEPHONE: (951) 217-0236
LICENSING EVALUATOR SIGNATURE:	DATE: 06/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2021

LIC9099 (FAS) - (06/04)

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