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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600345
Report Date: 06/28/2022
Date Signed: 06/28/2022 03:03:23 PM


Document Has Been Signed on 06/28/2022 03:03 PM - It Cannot Be Edited

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:MARIANO HERNANDEZFACILITY TYPE:
740
ADDRESS:504 S EL CAMINO REALTELEPHONE:
(760) 436-9990
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:90CENSUS: 61DATE:
06/28/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Executive Director Melissa WatkinsTIME COMPLETED:
10:50 AM
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Licensing Program Analyst (LPA) Iby Strong conducted a Case Management Visit during an unannounced Complaint Visit. LPA met with Executive Director Melissa Watkins discussed the purpose of the visit.

During a complaint investigation from 3/12/2020, LPA discovered, through interviews and record reviews, that Resident 1 (R1) who was under COVID-19 quarantine, was allowed to walk the facility grounds. This action exposed residents in care to COVID-19.

A technical assistant was issued on todays date. An exit interview was conducted, a copy of the report and Licensee/Appeal Rights (LIC 9058 01/16)1 were provided to Executive Director Melissa Watkins.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby StrongTELEPHONE: 619-481-0846
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022
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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