361880724-1-27-2023-18-AS-KCLS-CNLVUM-20230131154459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361880724
Report Date: 01/27/2023
Date Signed: 01/27/2023 12:08:41 PM

Substantiated

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
, 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 Bernadette Allen

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: 5	DATE:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Corazon Gapalad caregiver		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Licensee did not answer communications promptly and appropriately

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to deliver the findings for the above complaint conducted by Naisha Kendrix.

During the investigation LPA conducted 5 interviews. An interview revealed staff disconnected the facility's phone on 7/13/2020 from 6:15 PM - 9:15 PM. LPA found that the phone was disconnected by staff on more than one occasion between 7/12/2020 -7/18/2020 during the hours of 6 pm - 8 am. A friend of a resident attempted to contact them but was unable to speak to them due to the phone being disconnected. The facitliy failed to provide access to a telephone to receive confidential calls.

Based on LPA’s observations and interviews which were conducted by Naisha Kendrix, the preponderance of the evidence standard has been met, therefore the above allegation is found to be Substantiated, California Code of Regulations Title 22 is being cited on the attached LIC 9099D.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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-20200714091013

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
, CA 92507

FACILITY NAME: ATIENZA RESIDENTIAL CARE	FACILITY NUMBER: 361880724
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/27/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/28/2023 Section Cited CCR 87468.1(a)(14)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities ; (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (14) To have reasonable access to telephones.to both make and receive confidential calls.	1 2 3 4 5 6 7	The licensee has agreed to read the cited regulation entirley and provide a written statement signed by all staff members saying that the regulation was understood. The licensee will forward this stated to LPA Allen by 1/28/2023 by email or fax.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by: LPA found through interviews, staff disconnected the facility phone between the hours of 6 PM - 8 AM for at least one week, 7/12/20- 7/18/20 this poses an immediate danger to those in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Bernadette Allen	TELEPHONE: 951-897-2618
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

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