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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880723
Report Date: 09/19/2025
Date Signed: 09/19/2025 03:55:02 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
06/03/2025 and conducted by Evaluator Lavette Farlow
COMPLAINT CONTROL NUMBER: 56-AS-20250603100246
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: DATE:
09/19/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Caroline Armstrong, LicenseeTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff hits resident in care
Staff are blocking exiting doors for residents to have access to common areas
INVESTIGATION FINDINGS:
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On 9/19/2025, at approximately 9:10 AM, Licensing Program Analysts (LPAs) Lavette Farlow, and Edith Conchas conducted an unannounced visit to the facility to commence a complaint investigation and deliver the findings. LPAs were greeted and granted entrance at the door by Staff, Danica Reyes, Caregiver. LPAs identified themselves and discussed the purpose of the visit. LPAs also presented themselves to Licensee, Caroline Armstrong, and discussed the purpose of the visit. LPAs conducted interviews with staff and residents, reviewed documents and did a walk-through of the facility.

Allegation 1: Staff hits resident in care. LPA Farlow interviewed five (5) staff and four (4) residents. Interview with Residents R1, and R5 revealed that S2 hits residents in care. LPA Farlow interview with staff S1 and S3 revealed that S2 does hit and hug people. S1 stated they have not seen it but was aware of R1 stating it happened. S3 stated S2 does hit people but is not sure if it playful, but the behavior made S3 feel uncomfortable. S3 stated S2 does express behaviors of hitting other when talking. Therefore, this allegation is SUBSTANTIATED. A deficiency will be cited.
***Continued on LIC9099C***

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025
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-20250603100246
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
VISIT DATE: 09/19/2025
NARRATIVE
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Allegation 5: Staff are blocking exiting doors for residents to have access to common area. LPA interviews with staff and residents revealed that staff did not keep the pathway free from obstruction. Interview with S3 revealed S2 would obstruct the passageway with large water bottles. Therefore, this allegation is SUBSTANTIATED. A Deficiency will be cited.

Based on the evidence gathered during the investigation, the above allegations are found to be Substantiated. A finding that the complaint is Substantiated means that the allegations is valid because the preponderance of the evidence standard has been met per California Code of Regulations Title 22 are being cited on the attached LIC 9099D).

An exit interview was conducted where this report LIC9099, LIC9099-C and LIC9099-D and appeal rights was discussed and provided to Danica Reyes, Caregiver at the conclusion of the visit.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
06/03/2025 and conducted by Evaluator Lavette Farlow
COMPLAINT CONTROL NUMBER: 56-AS-20250603100246

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: DATE:
09/19/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Caroline Armstrong, LicenseeTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff are not answering call buttons in a timely manner
Staff leave residents soiled for an extended period of time
Staff are unable to communicate with residents
Licensee did not provide a refund upon resident's death
Staff are not properly supervising resident who may be a fall risk
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Lavette Farlow, and Edith Conchas conducted an unannounced visit to the facility to commence a complaint investigation and deliver the findings.

Allegation 2: Staff are not answering call buttons in a timely manner. LPA Farlow interviewed five staff and four residents. Interviews with staff revealed that staff do respond to the call button in a timely manner or when a resident calls out to staff. Interview with residents revealed that staff treat them well and assist them as needed. Based on the interviews this allegation is UNSUBSTANTIATED.

Allegation 3: Staff leave residents soiled for an extended period of time. LPA Farlow interviewed staff and residents in care. Interviews with S1, S2, S3, S4 and S5, revealed that staff does not leave residents soiled for an extended periods of time. LPA interview with R1, stated staff at night do not attend to residents needs and leave residents soiled. LPA interview and observation with R2, R3, R4, and R5 revealed that staff are changing residents, and staff are not leaving residents soiled for an extended period of time. R5 stated staff are very good about ensuring residents are clean. Based on the interviews and observation this allegation is UNSUBSTANTIATED.

Allegation 4: Staff are unable to communicate with residents. Interviews with staff and residents revealed that staff are able to communicate with residents in care and assisted them with their needs. Based on the interviews and observation this allegation is UNSUBSTANTIATED.

Allegation 6: Licensee did not provide a refund upon resident’s death. Interview with S1 and review of documents between S1 and witness revealed that a payment was received from responsible party. However, there wasn't any records to indicate a refund was requested or that the total amount paid was an over payment. LPA reviewed records and observed it was not clear whether the total amount received or paid by the responsible party required a refund. Based on the interviews and observation this allegation is UNSUBSTANTIATED.

Allegation 7: Staff are not properly supervising resident who my be a fall risk. Interview with staff and residents were conducted. Interviews with staff revealed they use a two man method to assist residents in care, and there has not been any issues with falls. Interviews with residents in care revealed that resident's receive assistance as needed to avoid any falls. Based on the interviews and observation this allegation is UNSUBSTANTIATED.

Based on the information above, the allegations are unsubstantiated. A finding of UNSUBSTANTIATED means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted where this report LIC9099 was discussed, and a copy was provided to Caregiver, Danica Reyes.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 56-AS-20250603100246
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: 09/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/19/2025
Section Cited
CCR
87468.1(a)(3)
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87468.1(a)Residents in all residential care facilities for the elderly shall...personal rights(3)... free from punishment,.. abuse, or other actions of a punitive nature, such as withholding residents’... interfering with daily living... This is evident by Licensee not...
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Licensee agree to conduct an in-service training for all staff to ensure residents personal rights and safety are safeguarded at all times. Licensee agrees to provide a statement of acknowledgement with all staff who participated in the training and acknowledgement of understanding of this regaulation and residents personal rights by POC date.
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Based on LPA interviews, Licensee did not comply with section cited above by not ensuring R1 was free from physical abuse, which poses a potential health, 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: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4