<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361880724
Report Date: 11/25/2025
Date Signed: 11/25/2025 03:48:56 PM

Unsubstantiated


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
11/24/2025 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20251124133424
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: 3DATE:
11/25/2025
UNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Caregiver Rosalinda PinellaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not provide adequate amount of incontinence supply
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Sarina Ramirez and Eldin Serrano conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPAs met with Caregiver Rose Pinella, and discussed the purpose of the visit.

Regarding Allegation above, LPA Serrano toured the facility and observed a sufficent amount of incontinence supplies. R1 receives incontinence supplies provided by Veterans Adminstration (VA). Based on LPAs interviewed two (2) of the three (3) residents receive incontinence care.

Based on LPA’s observations, staff and resident interviews, and relevant documentation, the allegation is determined to be Unsubstantiated. An Unsubstantiated finding means that although the allegation may be valid or could have occurred, there is insufficient evidence to support that the alleged violation did or did not happen.

An exit interview was conducted with Caregiver Rosalinda Pinella, and a copy of this report was provided at the conclusion of the visit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
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 3
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
11/24/2025 and conducted by Evaluator Sarina Ramirez
COMPLAINT CONTROL NUMBER: 56-AS-20251124133424

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: 3DATE:
11/25/2025
UNANNOUNCEDTIME BEGAN:
02:50 PM
MET WITH:Caregiver Rosalinda PinellaTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility does not dispense medication as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Sarina Ramirez and Eldin Serrano conducted an unannounced visit to the facility to conduct a complaint investigation on the above allegations. LPAs met with Caregiver Rosalinda Pinella, and discussed the purpose of the visit.

Regarding allegation above, all three (3) residents do not have a Medication Administration Record (MAR) for LPAs to review. LPAs could not verify if medication is dispensed as prescribed per physicians orders.

Therefore, this allegation is found to be SUBSTANTIATED. Facility will be cited accordingly for medication distribution. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met.

An exit interview was conducted with Caregiver Rosalinda Pinella, and a copy of this report with appeal rights was provided at the conclusion of the visit.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Citations on this Visit Report are Under Appeal!

Control Number 56-AS-20251124133424
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: 11/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type A
12/01/2025
Section Cited
CCR
87465(a)(6)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care
(a) A plan for incidental medical... shall be developed by each facility...(6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility.
1
2
3
4
5
6
7
Licensee will submit proof of tracking distribution for all three (3) residents and train all staff in medication distribution and provide to LPA by POC due date
8
9
10
11
12
13
14
Licensee/Administrator did not comply with the regulation above by not having a Medication Administration Record (MAR) for all residents which poses an immediate risk to the health and safety of residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Sarina Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 11/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3