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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880724
Report Date: 04/03/2025
Date Signed: 04/03/2025 02:43:10 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
03/28/2025 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250328140322
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: 4DATE:
04/03/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Remi Gallegos, StaffTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Staff do not keep the facility clean a sanitary

Staff do not provide residents with comfortable living accommodations

Staff does not provide resident's medication as prescribed
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto spoke with licensee Caroline Armstrong, who was unable to arrive and designated staff Remi Gallego to address the matters during this investigation. LPA Prieto toured the facility and interviewed resident #1 (R1), R2, R3, and R4 as well as staff #1 (S1) and S2.

LPA observed that the dresser drawers in R1's room does not close, scuffs on the walls and stained carpet. LPA also observed a small roach in the bedroom of R1. LPA observed a poorly repaired door T strike plate.

LPA observed spiders and their webs in the corners of the living room walls, broken door stopper in the bedroom of R2. LPA observed a plastic drawer in room of R3 and R4 that was not in good repair. Facility entrance door has old painter's tape with dirty baseboards.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
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 5
Control Number 56-AS-20250328140322
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
VISIT DATE: 04/03/2025
NARRATIVE
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Review of R1's medication reveals that R1 is not receiving two medications as prescribed. Facility staff did not refill medication for R1, causing R1 not to sleep comfortably through the night. Interview with R1 concurred the the medication was not refilled and not taken.

Based on LPA’s observations and interviews which were conducted by Javier Prieto, 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.

This report was signed by LPA Prieto and staff Delledo and a copy was left at the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 56-AS-20250328140322
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: 04/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/14/2025
Section Cited
CCR
87303(a)
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Maintenance and Operation
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
This requirement was not met as evidenced by:
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Licensee to clean and sanitized facility by POC date.
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LPA observed facility bedrooms with scuffed walls, dirty carpets, spiders and webs. LPA observed one small roach during inspection. Facility entrance door as dirty baseboards
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Type B
04/11/2025
Section Cited
CCR
87307(d)(2)
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Personal Accommodations and Services
The following space and safety provisions shall apply to all facilities: The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment. This requirement was not met as evidenced by:
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Licensee to repair or replace items mentioned in this report by POC date.
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LPA observes broken dresser drawers, broken picture frames, broken door stops. LPA also observed poorly repaired door slate plate.
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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: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 56-AS-20250328140322
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: 04/03/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/07/2025
Section Cited
CCR
87465(4)
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Incidental Medical and Dental Care
The licensee shall assist residents with self administered medications as needed.

This requirement was not met as evidenced by.
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Licensee to refill R1's medication and dispense medication by POC date. Proof to be texted to LPA.
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Interview with R1 and medication review would reveal that medication Clonazepam and Trazodone were not refilled and not dispensed.
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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: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
03/28/2025 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250328140322

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: 4DATE:
04/03/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Remi Gallegos, StaffTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is not physically capable to perform assigned task

Staff is unable to effectively communicate with residents or other persons
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegations. LPA Prieto spoke with licensee Caroline Armstrong, who was unable to arrive and designated staff Remi Gallegos to address the matters during this investigation.

LPA Prieto toured the facility and interviewed resident #1 (R1), R2, R3, and R4 as well as staff #1 (S1) and S2. Staff was able to communicate with LPA as well as residents in care as observed during time of investigation visit. Interview with R1 concluded that his needs are met by staff in transferring. Interview with R3 stated that S1 provides excellent care to residents at the facility. During time of visit LPA observed S2 assist R3 with transferring out of bed.

Based on the information obtained there is not enough evidence that staff is not physically capable to perform assigned task and staff is unable to effectively communicate with residents or other persons Therefore, the allegations that is deemed UNSUBSTANTIATED at this time. This report wsa signed by LPA Prieto and staff Gallegos.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 04/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 5