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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880724
Report Date: 08/18/2025
Date Signed: 08/18/2025 11:06:37 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO 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
08/12/2025 and conducted by Evaluator Eldin Serrano
COMPLAINT CONTROL NUMBER: 56-AS-20250812104335
FACILITY NAME:ATIENZA RESIDENTIAL CAREFACILITY NUMBER:
361880724
ADMINISTRATOR:ARMSTRONG, CAROLINEFACILITY TYPE:
740
ADDRESS:911 HARTZELL AVETELEPHONE:
(909) 792-3835
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:6CENSUS: 6DATE:
08/18/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Rosalinda Pinella, CaregiverTIME COMPLETED:
11:20 AM
ALLEGATION(S):
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Staff did not properly maintain facility sinks
INVESTIGATION FINDINGS:
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On August 18, 2025, Licensing Program Analyst (LPA) Eldin Serrano visited the facility to investigate the mentioned allegation and deliver findings. LPA met with Caregiver Rosalinda Pinella to discuss the purpose of the visit.

The investigation consisted of observation and interview of staff. The allegation indicates that Staff did not properly maintain facility sinks. LPA observed that the faucets on the facility kitchen sink and resident bathroom sink are both leaking water. Interview with staff revealed that both faucets were leaking for a while and the landlord fixed it but now the faucet is back to leaking again. Citation will be issued.

Based on observation and interview, the preponderance of evidence standard has been met, therefore, the allegation is substantiated under the California Code of Regulations (Title 22, Division 6 & Chapter 1).

An exit interview was conducted, where this report, LIC9099, and LIC9099D along with appeal rights, were provided to the Caregiver Rosalinda Pinella.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
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 2
Control Number 56-AS-20250812104335
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ATIENZA RESIDENTIAL CARE
FACILITY NUMBER: 361880724
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/29/2025
Section Cited
CCR
80087(a)
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80087(a)Buildings and Grounds:(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
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The licensee will submit proof that the facility kitchen sink faucet and residents bathroom sink faucet are fixed. Licensee will provide receipts/invoice from a licensed plumber that both faucets are fixed on the plan of correction (POC) due date.
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Based on observation the faucets on the facility kitchen sink and resident bathroom sink are both leaking water. The licensee did not ensure that the faucets are in good repair for the safety and well being of clients, employees and visitors.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:

DATE: 08/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2025
LIC9099 (FAS) - (06/04)
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