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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 366400985
Report Date: 10/29/2025
Date Signed: 10/29/2025 01:19:40 PM

Unsubstantiated


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
10/28/2025 and conducted by Evaluator Javier Prieto
COMPLAINT CONTROL NUMBER: 56-AS-20251028103601
FACILITY NAME:ATRIA DEL REYFACILITY NUMBER:
366400985
ADMINISTRATOR:DEGUZMAN, SAMUELFACILITY TYPE:
740
ADDRESS:8825 BASELINE RDTELEPHONE:
(909) 989-4346
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:145CENSUS: 90DATE:
10/29/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Alondra Fuentes, Executive Director TIME COMPLETED:
01:25 PM
ALLEGATION(S):
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Resident sustained multiple falls resulting in injury due to lack of supervision.

Facility staff does not ensure facility is kept in clean and sanitary at all times
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 met with Executive Director Alondra Fuentes and explained the elements of the complaint.

Allegation #1 - LPA Prieto interviewed Executive Director Fuentes (S1) who produced Resident Functional Needs Assessment for resident #1 (R1) in question, and reveals the R1 requires a walker for assistance and can leave the facility unassisted, per Physician's order. Assessment reveals that R1 is not a fall risk. R1 requires minimal assistance with bathing, vision and continence care. R1 does not require assistance with transfers and escorting. Assessment reveal that R1 does not requires status checks. Recent fall for R1, dated 10/02/2025, was documented on resident notes and an incident report was sent to Licensing as required by Title 22 regulations. Fall did not appear to have occurred due to lack of care and supervision.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
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 2
Control Number 56-AS-20251028103601
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: ATRIA DEL REY
FACILITY NUMBER: 366400985
VISIT DATE: 10/29/2025
NARRATIVE
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Allegation #2 - LPA Prieto toured the facility with Executive Director Fuentes and found to be clean, sanitary and free from obstructions. LPA toured R1's room and found it to be clean and sanitary. LPA obtained the facility Housekeeping Cleaning Schedule and found that R1's room is cleaned weekly. The records show that recent cleaning dated for R1's room was on 10/01, 10/08, 10/15 and 10/22.

Based on the information obtained there is not enough evidence to substantiate the allegations made in this complaint. Therefore, the allegations are deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and Executive Director Fuentes and a copy was left with the facility.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2