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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880723
Report Date: 08/27/2025
Date Signed: 08/27/2025 12:26:25 PM

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
08/18/2025 and conducted by Evaluator Edith Conchas
COMPLAINT CONTROL NUMBER: 56-AS-20250818213803
FACILITY NAME:ATIENZA RESIDENTIAL CAREFACILITY NUMBER:
331880723
ADMINISTRATOR:ARMSTRONG, CAROLINEFACILITY TYPE:
740
ADDRESS:1328 GALAXY DRTELEPHONE:
(951) 845-3565
CITY:BEAUMONTSTATE: CAZIP CODE:
92223
CAPACITY:6CENSUS: 4DATE:
08/27/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Licensee Caroline ArmstrongTIME COMPLETED:
12:40 PM
ALLEGATION(S):
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Staff do not meet a resident's diabetic needs while in care

Staff mishandle the resident's medications
INVESTIGATION FINDINGS:
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On 8/27/2025 Licensed Program Analysts (LPAs),Edith Conchas and Renese Howell- Small conducted an unannounced visit to the facility to commence a complaint investigation. LPAs identified themselves and discussed the purpose of the visit with the Licensee Caroline Armstrong.

During today's visit LPAs conducted observations, interviewed two staff, an agency caregiver and one (1) resident. LPA's also reviewed and obtained records.

It is alleged that staff do not meet a resident's diabetic needs while in care. An interview with resident 1 (R1) revealed that R1 takes diabetis medication and gets their blood sugar checked in the morning by staff. An Interview with Staff 1 (S1) revealed that insulin was given this morning around 8:00 am. LP reviewed the records and audited medications of R1 which reveleald that several medications that were audited, were not listed on the Centrally Stored Medications list. S1 stated that R1 needs assistance with medication administration and S1 is the only staff that assists R1 with the insulin. Based upon record review, interview and observation, this alllegation is SUBSTANTIATED.

It is alleged that staff mishandle the resident's medications.
An interview with S1 and staff 2 (S2) confirmed that the hospice agency trained staff on general medications, not on diabetic medications and diet. S1 stated that some of R1's medication(s) have been disconitnued, however, LPA's did not observe any documentation to support this. S2 stated that the S1 places the residents' medication in small cups and designates when they are to be given. S2 does not document the date/time/dosage. LPA's did not observe any documentation that the medication(s) were administered nor any menu avaible for diabetes patients. LPAs observed a single loose pill in R1's basket of medications. Based upon record review, observations and interview, this allegation is SUBSTANTIATED.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Edith Conchas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
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 4
Control Number 56-AS-20250818213803
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: 331880723
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/28/2025
Section Cited
CCR
87628(a)
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87628 Diabetes (a) The licensee shall be permitted to accept or retain a resident who has diabetes... including medication administered orally or through injection, or has it administered by an appropriately skilled professional. This requirement is not met as evidenced by:
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Administrator will conduct a staff training on diabetic diet and needs and submit a plan for diabetic care for R1 by the Plan of Correction (POC) due date.
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Based on interview and records review, the Licensee did not comply with section cited above by not following the physician's order of (R1) which poses an immediate Health and Safety and personal rights risks to residents in care.
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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: Edith Conchas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20250818213803
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: 331880723
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/10/2025
Section Cited
CCR
87628(b)(4)
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87628 Diabetes (b) (4) In addition to section 87611, General requirements for allowable health conditions, the licesnee shall be responsible for the following: Providing modified diets...physician as specified in Section 87555 (b) (7). This requirement is not met as evidenced by:
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Licensee will provide a diabetic menu for staff to follow based on physician orders and conduct a staff training on diabtic needs and submit proof to LPA by plan of correction POC due date.
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Based on interviews and records review, the Licensee did not comply with section cited above by not following and providng a proper diet for clients which poses a Potential Health and Safety and personal rights risks to residents in care.
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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: Edith Conchas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/27/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4