374600890-6-7-2023-08-AS-DPOL-CTAPQE-20230630113101

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 06/07/2023
Date Signed: 06/07/2023 09:10:46 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
05/24/2023 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20230524084730

FACILITY NAME:	ATRIA COLLWOOD		FACILITY NUMBER:	374600890
ADMINISTRATOR:	ARTEAGA, IRMA		FACILITY TYPE:	740
ADDRESS:	5308 MONROE AVE		TELEPHONE:	(619) 286-3583
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	185	CENSUS: 84	DATE:	06/07/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Business Director, Maritza Maezze		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident food was not of quality

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility after identifying herself. LPA met and disclosed the reason for the visit with Business Director, Maritza Maezze.

The Department investigated the above listed complaint allegation. The investigation consisted of a tour of the facility, staff and resident interviews and records review.

On May 24, 2023, Community Care Licensing (CCL) received a complaint alleging that resident (R1) [an LIC 811 Confidential Names List was provided to staff to identify the resident] food was not of quality. It was specifically alleged that on May 23, 2023, R1 was served a meal consisting of a quesadilla that was cold and had no cheese. The evidence provided by outside sources included a photograph of the meal in question.

(Continue on LIC9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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 4

Control Number 08-AS-20230524084730

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 COLLWOOD	FACILITY NUMBER: 374600890
	VISIT DATE: 06/07/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(continued from LIC9099)

The quality of the quesadilla could not be determined from the photograph. During the course of the investigation no other examples of food quality concerns were disclosed. On June 1, 2023, during a visit at the facility, observations revealed plentiful supply of non-perishable and perishable food supply all observed in good quality. Resident and staff interviews revealed that the quality of the food in the community was good with no complaints given. Record review revealed a three-week menu would get published and the same menu repeated every three weeks which provided a wide range of variety of healthy foods. The menu was developed by corporate office according to recommended nutritional requirements to meet resident’s needs. Interviews with residents confirmed the meals served on May 31, 2023, and June 1, 2023, were consistent with the meals as scheduled on the menu.

Based upon a lack of evidence to conclude that the above mentioned occurred, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Business Director, Maezze, and a copy of this report, LIC811 Confidential Names and Licensee/Appeal Rights (LIC 9058) were provided to staff at the conclusion of the visit.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
05/24/2023 and conducted by Evaluator Marisela Garcia-Centeno

COMPLAINT CONTROL NUMBER: 08-AS-20230524084730

FACILITY NAME:	ATRIA COLLWOOD		FACILITY NUMBER:	374600890
ADMINISTRATOR:	ARTEAGA, IRMA		FACILITY TYPE:	740
ADDRESS:	5308 MONROE AVE		TELEPHONE:	(619) 286-3583
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	185	CENSUS: 86	DATE:	06/07/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Business Director, Maritza Maezze		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not itemize resident's bill

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced visit to deliver investigative findings. LPA was granted entry into the facility after identifying herself. LPA met and disclosed the reason for the visit with Business Director, Maritza Maezze.

The Department investigated the above listed complaint allegation. The investigation consisted of a tour of the facility, staff and resident interviews and records review.

On May 24, 2023, Community Care Licensing (CCL) received a complaint alleging that the licensee did not itemize resident’s (R1) [an LIC 811 Confidential Names List was provided to staff to identify the resident] bill. It was specifically alleged that the R1 did not get an itemized account summary for a $6,000 bill that was delivered on May 23, 2023, until it was requested, and that it took 1 – 2 days for staff to provide it to R1.

(Continue at LIC9099C)

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 08-AS-20230524084730

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 COLLWOOD	FACILITY NUMBER: 374600890
	VISIT DATE: 06/07/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

(Continue from LIC9099A)

Outside sources were not able to provide a copy of the $6,000 bill or any other documentation for the bill that was delivered to R1. During a visit at the facility conducted on June 1, 2023, billing procedures were reviewed with staff. Per staff interviews all residents received their billing statements monthly between the 12th and 15th day of the month for the following month. The residents’ statements were mailed to each resident’s mailbox, or the residents had the option to have their statements hand delivered to their apartment at no extra charge. Staff delivered the billing statement to R1 as it was standard protocol. In addition, detail review of R1’s billing statements and the respective itemized account summary from February 23, 2023, through June 1, 2023, indicated no billing discrepancies with R1’s account. According to staff interviews and records review, per R1’s requests, R1 was provided an itemized account summary on May 3, 11, 16 and 25, 2023. Based on observations and staff interviews there was no evidence to support the allegation. Therefore, this allegation is deemed to be unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with Business Director, Maezze to whom a copy of this report, LIC811 Confidential Names form, and Licensee Appeal Rights (9058 01/16) were provided at the conclusion of the visit.

SUPERVISOR'S NAME: John Rante	TELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 06/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4