374600344-12-19-2022-08-AS-SJAB-CMHTTK-20221227140052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600344
Report Date: 12/16/2022
Date Signed: 12/19/2022 09:57:33 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/04/2020 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20200504141823

FACILITY NAME:	ATRIA ENCINITAS NORTH		FACILITY NUMBER:	374600344
ADMINISTRATOR:	MARTINEZ, USBALDO		FACILITY TYPE:	740
ADDRESS:	480 S EL CAMINO REAL		TELEPHONE:	(760) 436-6955
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	0	CENSUS: 0	DATE:	12/16/2022
		UNANNOUNCED	TIME BEGAN:	09:04 AM
MET WITH:	Closed Facility - Report sent via USPS Certified Mail		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff member is stealing from resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Debbie Correia sent this report to the Licensee's last known mailing address, via USPS certified mail, to deliver the investigation findings for the above listed allegations. The facility was closed on September 21, 2022.

The Department’s investigation consisted of outside source interviews and a Resident1 (R1) records review.

It was alleged a staff member was stealing from Resident1 (R1). R1 was admitted to the facility on August 31, 2019, was 96 years old, and had a diagnosis of Gastreoesphigeal Reflux Disease (GERD), Congestive Heart Failure, Insomnia, and Anxiety. Interviews with outside revealed R1 experienced extreme paranoia and anxiety and Sun Downing behaviors. The interviews with outside sources corroborated that prior to facility admission R1 also had a chronic behavior of accusing people of stealing from them. An outside source interview also revealed when R1's Power of Attorney (POA) moved R1 out of the facility and all R1's personal belongings were present at the time of discharge. A facility records review of R1's facility Admission Agreement revealed no personal belongings listed when moving in and was signed off and dated by R1's POA.

Based on interviews and record reviews the finding regarding the above allegation was determined to be unsubstantiated. This finding means although the allegation may have happened or could be valid, there is not a preponderance of evidence to prove that the alleged violation occurred.

Due to the facility’s closure, no exit interview was conducted. A copy of this report, along with Licensee Rights (LIC 9058 01/16), were mailed via USPS certified mail to the last mailing address on file.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 12/16/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2022

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