374600345-6-28-2022-08-AS-JRAE-CFVSGM-20220630135211

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600345
Report Date: 06/28/2022
Date Signed: 06/28/2022 03:01:46 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
03/12/2020 and conducted by Evaluator Iby Strong

COMPLAINT CONTROL NUMBER: 08-AS-20200312115325

FACILITY NAME:	ATRIA ENCINITAS SOUTH		FACILITY NUMBER:	374600345
ADMINISTRATOR:	MARTINEZ, USBALDO		FACILITY TYPE:	740
ADDRESS:	504 S EL CAMINO REAL		TELEPHONE:	(760) 436-9990
CITY:	ENCINITAS	STATE: CA	ZIP CODE:	92024
CAPACITY:	90	CENSUS: 61	DATE:	06/28/2022
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Executive DIrector Melissa Watkins		TIME COMPLETED:	10:50 AM

ALLEGATION(S):

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Staff violated resident(s) Personal Rights

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to deliver findings in the above complaint allegation. LPA identified herself and discussed the purpose of the visit with Executive DIrector Melissa Watkins.

On March 12, 2020, Community Care Licensing received a complaint alleging Licensee violated resident’s personal rights, specifically that R1 was place in quarantine. During LPA Strong’s investigation it was established that a Proclamation of a State of Emergency was issued by the Governor of the State of California on March 4, 2020. This proclamation requested implementation of measures to mitigate the spread of COVID-19 to be set in place to protect elderly and high-risk individuals.

Interview with the Executive Director revealed that the Licensee had implemented Provider Information Notice(PIN) 20-04-ASC as of March 5,2020 which states, “Facilities should prepare for possible impacts of COVID-19 and take precautions to prevent the spread of COVID-19 as well as other infectious diseases…”.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 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.

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20200312115325

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 SOUTH	FACILITY NUMBER: 374600345
	VISIT DATE: 06/28/2022

NARRATIVE

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Record reviews showed Licensee attained guidance from resident’s Primary Care Provider who recommended isolation of exposed residents of a high-risk environment. Interview with the victim revealed that resident was provided with personal protective equipment (PPE) to move freely throughout the facility walk-way. Further review of PIN 20-07-ASC released as of March 13, 2020 required facilities to isolate any COVID-19 exposed residents and limit contact to prevent the spread of this disease. Licensee confirmed that resident was issued PPE for walks in the facility’s courtyard during resident’s quarantine.

Based on LPA's interviews and records review, there is not a preponderance of evidence to prove alleged violation occurred, therefore the allegation is unsubstantiated. An exit interview was conducted with Executive Director Melissa Watkins, to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058 01/16) were provided.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Iby Strong	TELEPHONE: 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

LIC9099 (FAS) - (06/04)

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