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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 07/06/2023
Date Signed: 08/15/2023 06:37:06 AM

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
05/04/2023 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20230504115823
FACILITY NAME:ATRIA COLLWOODFACILITY NUMBER:
374600890
ADMINISTRATOR:ARTEAGA, IRMAFACILITY TYPE:
740
ADDRESS:5308 MONROE AVETELEPHONE:
(619) 286-3583
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:185CENSUS: 90DATE:
07/06/2023
UNANNOUNCEDTIME BEGAN:
12:40 PM
MET WITH:Assistant Executive Director (AED) April PrincesaTIME COMPLETED:
01:08 PM
ALLEGATION(S):
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Management retaliation against staff regarding reporting requirements.
INVESTIGATION FINDINGS:
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*This is an amended report.

Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver findings on the above listed complaint allegation. LPA identified herself, was granted entrance, and discussed the purpose of the visit and the basic elements of the allegation mentioned above with (AED) April Princesa.

The Department's investigation included a staff records review, and staff and outside source interviews.

It was alleged that facility management retaliated against a staff member regarding reporting requirements. Interviews with facility staff revealed a colleague, Staff (S1), was retaliated against by facility management. A review of S1’s facility records revealed no corroborating evidence of retaliation. An interview conducted with S1 revealed there was a misunderstanding regarding the allegation and denied being retaliated against. An interview with facility management also revealed no corroborating evidence regarding the allegation.



Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
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 2
Control Number 08-AS-20230504115823
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: 07/06/2023
NARRATIVE
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Due to lack of corroborating evidence, the finding regarding the above allegation was established 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.

LPA Correia conducted an exit interview with AED Princesa. At the time of the exit interview AED Princesa was advised a copy of the Complaint Investigation Report (LIC9099) and Licensee Rights (LIC9058 01-2016) will be provided and signature on this report acknowledges receipt of the documents.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2