374600890-1-26-2024-08-AS-SJAB-D2NM6G-20240221081953

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 01/26/2024
Date Signed: 01/26/2024 03:13:35 PM

Substantiated

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
07/17/2023 and conducted by Evaluator Daniel Pena

COMPLAINT CONTROL NUMBER: 08-AS-20230717144036

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: 91	DATE:	01/26/2024
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Julia Lopez, Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Licensee did not provide resident's personal care needs

INVESTIGATION FINDINGS:

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On 01/26/2024, at about 2:00 PM, Licensing Program Analyst (LPA) Daniel Pena conducted a complaint investigation visit to the facility. After identifying himself, and explaining the purpose of the visit, LPA was allowed inside the residence. LPA discussed the elements of the complaint with Executive Director, Julia Lopez.

The Department's investigation included facility visits, interviews with pertinent staff and outside sources and review of facility and resident records.

On 07/17/2023, the Department received a complaint alleging staff did not provide a resident’s personal care needs. Records and statements revealed that Resident 1 (R1) did not receive a shower on July 15, 2023. An outside source stated that on July 15, 2023, they went to the facility to visit R1. An outside source asked a staff member when R1 would receive a shower. Records indicate R1 was scheduled to receive a shower on that date. Staff confirmed to the outside source that they would assist R1 at their scheduled shower time.

Substantiated

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: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

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-20230717144036

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: 01/26/2024

NARRATIVE

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Later that same evening, a staff notified the outside source by telephone informing them that staff would not be able to provide R1 with a shower because staff was limited.

Staff interviews contend R1 refused the shower. When reviewed, shower records did not reflect a notation that R1 refused their shower. Statements and records did confirm R1 received a shower on July 16, 2023. Record reviews showed that R1 also did not receive a scheduled shower on July 18, 2023. Staff interviews could not state for certain whether the resident refused the shower, or if one was offered. Staff interviews revealed that staff are not trained to document if and when a resident refuses showers.

Based on interviews and record reviews, the Department’s investigation obtained sufficient evidence to support the allegation that the facility did not afford resident’s personal care needs. The Preponderance of Evidence standard has been met. Therefore, the allegation is Substantiated.

California code of Regulations, Title 22, Division 6 & Chapter 1 is being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report along with the Licensee Rights (LIC 9058 01/16) were provided to Director, Lopez whose signature below confirms receipt of these rights.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

LIC9099 (FAS) - (06/04)

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Control Number 08-AS-20230717144036

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/26/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/01/2024 Section Cited HSC 87464(f)(4)	1 2 3 4 5 6 7	(f)…shall at a minimum include…(4) Personal assistance and care…with those activities of daily living such as dressing, eating, bathing and assistance with taking prescribed medications. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee agreed to procure vendorized training on Personal Rights and Basic Services and ensure 100 percent staff participation. Licensee will furnish written proof of contract to CCLD by 01/29/2024. Licensee will ensure training is completed and submit written proof no later than 03/01/2024.
	8 9 10 11 12 13 14	Based on interviews, the Licensee did not ensure R1 was provided personal assistance, which posed a potential health, safety, and personal rights risk to 1 of 185 residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Daniel Pena	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 01/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2024

LIC9099 (FAS) - (06/04)

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