361880724-7-24-2020-18-AS-KCLS-CNLVUN-20230131154500

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880724
Report Date: 07/23/2020
Date Signed: 07/24/2020 10:37:11 AM

Unsubstantiated

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
07/14/2020 and conducted by Evaluator Naisha Kendrix

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20200714091013

FACILITY NAME:	ATIENZA RESIDENTIAL CARE		FACILITY NUMBER:	361880724
ADMINISTRATOR:	ARMSTRONG, CAROLINE		FACILITY TYPE:	740
ADDRESS:	911 HARTZELL AVE		TELEPHONE:	(909) 792-3835
CITY:	REDLANDS	STATE: CA	ZIP CODE:	92374
CAPACITY:	6	CENSUS: 4	DATE:	07/23/2020
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Caroline Armstrong		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff left residents unsupervised at facility

INVESTIGATION FINDINGS:

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Due to the Department’s implementation, and in following current public health guidance, this report will be delivered via tele-visit. Licensing Program Analyst (LPA) Naisha Kendrix identified herself to the administrator, Caroline Armstrong, and stated the reason for the tele-visit was to tour the facility and deliver the finding for the above allegation.

During the investigation, LPA conducted five interviews of the residents, staff, and the reporting party. Four of the five interviews conducted denied that residents were left unsupervised at the facility at any time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted where this report was reviewed with the Licensee. The licensee will review the report and return the signed report within 24 hours of receipt.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Edna Musoke	TELEPHONE: (951) 248-0336
LICENSING EVALUATOR NAME: Naisha Kendrix	TELEPHONE: (951) 204-4307
LICENSING EVALUATOR SIGNATURE:	DATE: 07/23/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/23/2020

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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