374600344-1-30-2023-08-AS-SJAB-CNLVF3-20230131152316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600344
Report Date: 01/30/2023
Date Signed: 01/30/2023 08:31:45 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, 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
12/02/2020 and conducted by Evaluator Debbie Correia

COMPLAINT CONTROL NUMBER: 08-AS-20201202140754

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:	01/30/2023
		UNANNOUNCED	TIME BEGAN:	04:00 PM
MET WITH:	Closed Facility - Report sent via USPS Certified Mail		TIME COMPLETED:	05:45 PM

ALLEGATION(S):

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Facility staff failed to safeguard resident's personal property.

INVESTIGATION FINDINGS:

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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 resident and outside Source records review.

It was alleged facility staff did not safeguard Resident's (R1's) personal property. A review of Outside Source1 (OS1) records revealed R1 was moving rooms at the facility and left a box outside of their room filled with personal belongings, R1's left their cellular phone on top of the box and upon returning to their room, R1's phone was gone. The records also revealed, upon moving into their new room, R1 realized two (2) rings were missing as well. OS1 records revealed there were no suspects identified regarding the missing items. An Outside Source (OS2) interview revealed no knowledge of the missing items, and a review of R1's resident records revealed these items were not listed in R1's facility records, and there was no documentation of the incidents.

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: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20201202140754

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ATRIA ENCINITAS NORTH	FACILITY NUMBER: 374600344
	VISIT DATE: 01/30/2023

NARRATIVE

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Based on interviews and record reviews, and lack of evidence, 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.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie Correia	TELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2023

LIC9099 (FAS) - (06/04)

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