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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600345
Report Date: 09/23/2020
Date Signed: 09/23/2020 07:20:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ATRIA ENCINITAS SOUTHFACILITY NUMBER:
374600345
ADMINISTRATOR:RICHARDSON, PAULFACILITY TYPE:
740
ADDRESS:504 S EL CAMINO REALTELEPHONE:
(760) 436-9990
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:90CENSUS: 77DATE:
09/23/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Executive Director, Paul Richardson.TIME COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA), Natasha Persaud, contacted the facility via telephone regarding a Case Management - Incident. The visit is being conducted via telephone due to COVID-19. LPA identified herself and explained the purpose of the call to Executive Director (ED), Paul Richardson.

During the visual conference with the Executive Director, LPA briefly toured facility, interviewed staff, requested records, and obtained additional information. On 09/22/20, Community Care Licensing received a self reported incident involving Resident #1 (R1). On 09/21/20, R1 eloped from the facility. R1 was located and brought back safely by facility staff. No deficiencies were issued.

An exit interview was conducted with Executive Director, Paul Richardson., via virtual visit, and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Executive Director via electronic mail. An electronic read receipt confirmation was requested to be sent by the Executive Director upon receipt of the documents. [See LIC 811 Confidential Names List to identify Resident #1 ]
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Natasha PersaudTELEPHONE: (619) 301-3594
LICENSING EVALUATOR SIGNATURE:

DATE: 09/23/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2020
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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