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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366400985
Report Date: 10/23/2024
Date Signed: 10/23/2024 02:19:26 PM

Document Has Been Signed on 10/23/2024 02:19 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:ATRIA DEL REYFACILITY NUMBER:
366400985
ADMINISTRATOR/
DIRECTOR:		DEGUZMAN, SAMUELFACILITY TYPE:
740
ADDRESS:8825 BASELINE RDTELEPHONE:
(909) 989-4346
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY: 145CENSUS: 82DATE:
10/23/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:45 AM
MET WITH:Suby Kumar - Executive DirectorTIME VISIT/
INSPECTION COMPLETED:
02:25 PM
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a case management visit relating the physical plant and any maintenance issues the facility may have. LPA Prieto met with Executive Director Suby Kumar and toured the facility. Tour of the facility was focused in the first floor, where the Executive offices, dinning room and kitchen, common bathrooms, lobby area, living room, med tech nurses office and residents rooms are located. Photos were taken of these areas and the area was found to be clean and free from odors and clutters pertaining to the common areas.

An incident did occur in a residential room on the first floor on 08/13/2024, when the water line from a resident bathroom leaked at 3AM. Interview with resident stated the he went to bed around 1:30 in the morning. He also added that the leak affected the rooms next door that was vacant. This incident was reported to staff by resident and addressed by the Maintenance Director right away and the water was shut off to that specific bathroom. Contractors were called out to the facility, and repairs were completed within 2 hours. An invoice was obtained by LPA of this service. Follow up work was done in both rooms where the carpet and sections of dry wall was replaced. A copy of the invoice for these services were also obtained by LPA during this visit. Repairs were isolated to the residents rooms and did not effect or disrupt the offices, common bathrooms, lobby area, dinning area or kitchen area.

Interview with resident in question, stated the leak was not due to negligence of staff and he was moved to another room for a temporary period of approximately 1 week. LPA interviewed resident in his room and took photos of the bathroom, bathroom walls, room entry area and adjacent areas outside the room. No evidence of damage was visible during this visit. Case management tour was concluded and LPA Prieto and Executive Director Kumar signed this report and a copy was left at the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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