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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000372
Report Date: 07/06/2020
Date Signed: 07/09/2020 03:06:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ATRIA DEL SOLFACILITY NUMBER:
306000372
ADMINISTRATOR:HARMON, TERESA LFACILITY TYPE:
740
ADDRESS:23792 MARGUERITE PKWYTELEPHONE:
(949) 458-1176
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY:120CENSUS: DATE:
07/06/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Terri HarmonTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Kimberly Lyman contacted the facility via telephone to commence a case management via telephone due to COVID-19 and pre-cautionary measures. LPA identified herself and discussed the purpose of the call with Executive Director Terri Harmon.

Incident report dated 06/22/20 indicated Resident 1's (R1) responsible party reported to Executive Director that a private caregiver, Staff 1 (S1) had written a check out of RI's bank account in the amount of $13,000 dollars. Staff 1 is employed through a staffing agency. Staffing agency as well as law enforcement was notified and S1 was terminated from working privileges at the facility. During the visit, LPA spoke with Executive Director about the incident and verified that facility will not be offering S1 assignments at the facility. S1 is not associated to the facility.

An exit interview was conducted with Executive Director via telephone and a copy of this report was provided via email and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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