374600890-2-6-2024-08-AS-SJAB-D2P2HW-20240221162525

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 02/06/2024
Date Signed: 02/06/2024 01:04:37 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 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
05/22/2023 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20230522153113

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:	02/06/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Julia Lopez, Executive Director		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff inappropriately spoke to resident in care
Staff inappropriately made false accusation against a resident in care

INVESTIGATION FINDINGS:

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On 2/6/2024 at about 10:30 AM, Licensing Program Analyst (LPA), Daniel Pena, conducted an unannounced visit to the facility. The purpose of the visit was to follow up on a complaint investigation. LPA spoke with Receptionist, Karen Eugene, and after identifying himself, was permitted into the facility. LPA met with Executive Director, Julia Lopez, and discussed the complaint. At the conclusion of today's visit, LPA delivered findings to Director Lopez.

On 5/22/2023, the Department received a complaint alleging staff inappropriately spoke to and made false allegations against a resident in care. The investigation consisted of unannounced facility tours, record review and interviews with pertinent residents, staff, and outside sources.

It was alleged that staff verbally assaulted Resident (R1). When asked how staff verbally assaulted R1 no details were provided. According to an interview with R1, staff said the resident was suicidal and implemented one on one supervision. R1 told facility management they did not require extra supervision

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024

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-20230522153113

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ATRIA COLLWOOD	FACILITY NUMBER: 374600890
	VISIT DATE: 02/06/2024

NARRATIVE

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and would not pay for the additional care. The resident stated that the facility charged additional fees for “personal care.”

Additionally, it was alleged that the facility said R1 made threats to kill relatives in another state. When interviewed, R1 denied making the statements. The facility self-reported the incident. Reporting noted that the facility called 911 because R1 wanted paramedics to check their blood pressure and blood sugar. The records reflect that upon assessment, responding medics checked R1’s vitals and they were normal. Due to the statements made, the facility also called police and a crisis team to evaluate R1. Reporting and statements concluded that R1 refused treatment and denied making the threat. R1 was not hospitalized. Interviews with staff and outside sources indicate that R1 did in fact make the statements.

Following the incident, the facility admittedly applied one to one supervision of R1 without the resident’s consent. R1 told the facility they would not pay for the additional care and supervision. LPA conducted interviews and reviewed facility records associated with this incident. Records and interviews indicate that the facility did apply the additional services due to safety concerns for R1. However, records showed that R1 was not charged for the additional services. Additionally, the facility has policy to implement one to one supervision for safety reasons and it’s noted in R1’s Admission Agreement.

Outside source interviews reported that R1 held an unrealistic expectation of the service they should be provided by the facility staff. LPA interviewed an outside source close to R1 and assisted R1 in their admission into the facility. The outside source told LPA that R1 became very demanding of them and facility staff. The source did not know but thought it was R1's health conditions were worsening that were causing R1's difficult behavior. At one point, this source asked the facility to remove them as an emergency contact to R1.

Based upon the evidence gathered during this investigation, insufficient information was obtained to support the allegations. The Preponderance of Evidence Standard was not met. As such, the allegations are Unsubstantiated.

An exit interview was conducted with Director, Lopez and a copy of the report and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to Director, Lopez, whose signature confirms receipt of receiving the documents.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2024

LIC9099 (FAS) - (06/04)

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