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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 06/06/2023
Date Signed: 06/07/2023 05:43:04 PM

Substantiated


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
03/28/2023 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20230328090405
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: 85DATE:
06/06/2023
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Community Business Director (CDB) Maritza Maezze and Maintenance Director (MD) Omar ZamudioTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Insufficient staffing to meet Resident's needs.
Staff neglect resulting in health conditions.
Staff did not provided residents with healthful accommodations.
Staff did not follow reporting requirements.
Staff intimidated residents.
Staff did not secure centrally stored medications.
Staff did not administer medication as prescribed.
Licensee did not provide staff with required training.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above complaint allegations. LPA Correia met with Community Business Director (CDB) Maritza Maezze and Maintenance Director (MD) Omar Zamudio to whom was explained the purpose for the visit.

The Department’s investigation included a review of facility, staff, and resident records, and outside source evidence, along with interviews of facility staff, residents and outside sources.

It was alleged the facility had insufficient staffing to meet residents’ needs. A facility records review determined residents’ “levels of care” were determined by an assessment that calculated the hours of care each resident required per week, based on the resident’s needs. The levels of care ranged from 0-6, with a care level of ‘0’ meaning the resident did not require any care, up to a care level of ‘6’ for residents who required high amounts of care.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

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

DATE: 06/06/2023
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 11
Control Number 08-AS-20230328090405
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: 06/06/2023
NARRATIVE
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An audit of R1’s daily medication, prescribed to manage R1’s primary medical diagnosis, confirmed R1 missed approximately 4 doses. Additionally, on 3/20/2023, R1’s PCP placed a “hold” on R1’s blood pressure medication yet facility staff continued to administer this medication for approximately 8 days after the medication hold was issued. Interviews with outside sources revealed that the correct administration of medication was required to treat R1’s acute health condition. Records review determined that when medications were administered correctly, R1’s baseline remained stable, and they were primarily able to manage their own activities of daily living (ADLs).

Interviews and records reviews revealed on May 12, 2023, R1 was found unresponsive by facility staff and sent to the Emergency Room (ER). Outside source records revealed at the time of the ER admission, R1's blood pressure level was out of range, and R1 still tested positive for a UTI. Outside source interviews and record reviews revealed several of R1’s medications that were not given as prescribed had side effects including, but not limited to: confusion, lethargy, and loss of bladder control. Similarly, the presence of a UTI also had symptoms such as confusion, incontinence, and frequent falls. An outside source interview and facility records review revealed facility staff reassessed R1 from a care level 2 to an increased care level of 5. The reassessment occurred during the time staff were not administering medication as prescribed, which contributed to acute side-effects that led to R1 requiring additional care. A facility record review revealed the reassessment included additional “escort services” due to R1 having falls. However, interviews with staff and an outside source and LPA observation after R1’s Responsible Party (RP) was notified about the change in level of care revealed R1 was seen ambulating throughout the facility on several occasions, unaccompanied by an escort.

In addition to R1’s incidents of medication errors noted above, multiple staff interviews revealed they had observed many other medication errors during this time. A facility records review and review of outside source evidence confirmed medications were found unsecured throughout the facility. Records review also revealed on several occasions, facility staff notated and communicated the medication errors to facility management. Interviews and records review also revealed incidents where pills were found on the floor throughout the facility, including pills found in R1’s room that were not prescribed to R1.

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

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

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 11
Control Number 08-AS-20230328090405
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: 06/06/2023
NARRATIVE
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The facility census was 80 residents during this time, and records showed that approximately half of residents were assessed at a care level of 0, while slightly over one-fifth were at level 1, and the remainder of residents ranged between levels 2-5. However, a review of records of residents who were assessed at a care level of 0, revealed that these residents were in fact provided care services by facility staff. Based upon individual records review, the assigned care levels gave an inaccurate account of the overall amount of care required to meet residents’ actual needs. A review of the facility staff schedule (that included caregivers and med-techs) revealed there were shifts that only had one staff member scheduled on duty. Interviews further revealed staff stated they felt overwhelmed and unable to meet residents needs due to working shifts without assistance and staff consistently indicated this was because of the facility being understaffed.

It was alleged staff neglect resulted in health conditions. Additionally, it was alleged staff did not administer medication as prescribed. An interview conducted with an outside source and facility records review revealed Resident1 (R1) was diagnosed with a Urinary Tract Infection (UTI) on November 23, 2022. Outside source and facility staff interviews, as well as a review of facility and outside source records revealed staff did not administer R1’s antibiotic which was prescribed to be given on the same night of R1’s UTI diagnosis. A facility records review and interviews conducted with outside sources also revealed facility Staff 2 (S2) routinely gave R1 their antibiotics with a large amount of water. Due to their primary medical diagnosis, R1 would regurgitate from the water intake and expel the prescribed antibiotic. Staff and outside source interviews revealed on one occasion R1’s antibiotic was found in the trash, and S2 was observed re-administering the same medication to R1 after retrieving it from the trash. On another occasion, one of the antibiotic pills was found in R1’s sink. A follow up medical appointment on January 23, 2023, determined R1 was still positive for a UTI, and the infection had spread. Outside source interviews revealed that during R1’s follow up medical appointment, R1’s Primary Care Provider (PCP) recommended the medication be given in an alternative manner. Interviews conducted with an outside source revealed that instructions were provided to facility staff. Staff and outside source interviews revealed when R1 was given their medication as recommended, they were able to take the medication with ease; however, S2 continued to give large amounts of water causing R1 to continue to regurgitate the water and the medication. Interviews and record reviews revealed R1 began to refuse the antibiotic when it was administered by S2.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

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

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 11
Control Number 08-AS-20230328090405
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: 06/06/2023
NARRATIVE
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It was alleged facility staff did not provide healthful accommodations. An outside source interview revealed R1 had an occurrence of a bowel accident and R1’s linens had remnants of fecal matter that staff did not address by providing clean linens. A review of secured documentation corroborated the allegation. Interviews with facility staff also confirmed finding residents left in soiled undergarments and linens on multiple occasions. Further review of documentation noted R1's trash to be overflowing with used incontinence care supplies. Additionally, staff interviews revealed they had observed resident rooms to be unkempt, and residents left in soiled undergarments due to the facility’s lack of staff.

It was also alleged staff were not following reporting requirements. Interviews conducted with facility staff and outside sources corroborated being verbally intimidated or reprimanded by facility management when reporting incidents. Staff interviews revealed being trained on a reporting system to input incidents that occurred during their shifts; however, when they reported incidents as they had been trained, they were reprimanded by management. Staff interviews also corroborated that facility management had the capability of deleting or manipulating submitted reports. An interview conducted with a staff member revealed taking pictures of their reports prior to submission as proof that they fulfilled reporting requirements. A review of secured documentation confirmed staff were instructed not to report incidents, mostly noted as medication errors. Staff interviews revealed being shouted at by management, and observing other staff being reprimanded after they reported an incident. Interviews with facility staff also revealed that during a meeting, management instructed staff to refer Licensing to management if being questioned about anything related to a resident’s health condition.

Additionally, it was alleged staff intimidated residents. Interviews conducted with several staff members confirmed having directly witnessed facility management shout at and/or be rude to residents in care on multiple occasions. An interview with Resident 2 (R2) revealed that after submitting a complaint anonymously, facility management confronted them in an intimidating and harsh manner and claimed they had knowledge of R2’s complaint.

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

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

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 11
Control Number 08-AS-20230328090405
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: 06/06/2023
NARRATIVE
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It was also alleged staff were not provided with appropriate training. Interviews conducted with residents and staff corroborated staff were not provided with required basic training to meet resident care needs. An interview with Staff 4 (S4) stated they started training but by their third day at work they were left providing care on their own, with no other staff present to assist. Interviews with facility staff, staff records review, and a review of other secured documentation confirmed untrained care staff were working in roles they had not been hired or trained for.

Additionally, it was alleged staff intimidated residents. Interviews conducted with several staff members confirmed having directly witnessed facility management shout at and/or be rude to residents in care on multiple occasions. An interview with Resident 2 (R2) revealed that after submitting a complaint anonymously, facility management confronted them in an intimidating and harsh manner and claimed they had knowledge of R2’s complaint.

Based on records reviews, interviews and observations, the above allegations were determined to be substantiated. A substantiated finding means the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies are cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations and are listed on the LIC 9099-D.

An exit interview was conducted with CBD Maezze and MD Zamudio and a copy of this report and Licensee/Appeal Rights [LIC 9058 (3/22)] were provided to CBD Maezze and MD Zamudio . Signature on this form acknowledges receipt of the documents.


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

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

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 11
Control Number 08-AS-20230328090405
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
07/28/2023
Section Cited
CCR
87464(f)(1)
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Basic Services (f)(1) (f) Basic services shall at a minimum include:(1) Care and supervision.

This requirement was not met as evidenced by:
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CBD and RSD will have care staff attend a training regarding providing proper elder care by a CCL approved agency. In addition, CBD and RSD will coordinate an audit of a sample of residents care plan, appraisals/assessments, and progress notes to ensure they are accurately addressing residents needs.

CBD and RSD will provide proof of completion by all staff by POC due date.
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Based on records review and interviews, facility personnel did not provide basic care services to (R1) one out of 80 residents.

This posed an immediate health risk to a resident in care.
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Deficiency Dismissed
Type A
07/28/2023
Section Cited
CCR
87465(d)(2)
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Incidental Medical and Dental Care. If the resident is unable to determine...own need for a prescription or nonprescription PRN medication, ...facility staff ...assist ... provided all of the...requirements... (2) Once ordered by the physician the medication is given according to the physician's directions.

This requirement was not met as evidenced by:
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CBD and RSD will implement a Quality Control system, approved by CCL, to ensure medications are administered as prescribed, additionally CBD and RSD will have all med-techs attend training regarding medication management by a CCL approved agency.

CBD and RSD will provide proof of completion by all staff by POC due date.
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Based on records review and interviews, facility personnel did not give medication as prescribed to (R1) one out of 80
residents.

This posed an immediate health risk to a resident in care.


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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 JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

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

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 11
Control Number 08-AS-20230328090405
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
07/28/2023
Section Cited
CCR
87411(a)
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Personnel Requirements – General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.

This requirement was not met as evidenced by:
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CBD has hired 3 new staff (2 care, and 1 med tech) since the complaint was filed. In addition, 2 more care staff are in the hiring process. CBD and RSD will also coordinate an on-call staff schedule to cover staff call outs on a scheduled shift. CBD and RSD will provide proof of completion, including an updated LIC 500, and a schedule/list of the assigned on-call staff by POC due date.
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Based on records review and interviews, facility personnel were not sufficient to meet the needs of (R1) 1 out of 80 residents.

This posed a potential health risk to residents in care.

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Deficiency Dismissed
Type B
07/28/2023
Section Cited
CCR
87468.1(a)
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Personal Rights of Residents in All Facilities
Residents…shall have all the following personal rights: To be accorded safe, healthful and comfortable accommodations…

This requirement was not met as evidenced by:
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CBD and RSD have agreed to have all care staff and management attend a training regarding resident rights, requesting an emphasis on proper incontinent care, by a CCL approved agency.

CBD and RSD will provide proof of completion by all staff by POC due date.
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Based on records review and interviews, the facility did not accord healthful accommodations to (R1) one of 80 residents in care.

This posed a potential personal rights risk to residents in care.

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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 JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

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

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 7 of 11
Control Number 08-AS-20230328090405
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
07/28/2023
Section Cited
CCR
87211(1)(D)
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Reporting Requirements (1) A written report shall be submitted to the licensing agency…within seven days of the occurrence of… (D) Any incident which threatens the welfare, safety or health of any resident…

This requirement was not met as evidenced by:
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CBD and RSD have agreed to have all care staff attend a training regarding reporting requirements per Title 22 by a CCL approved agency. CBD Maezza will provide proof of completion by all staff by POC due date.
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Based on records review and interviews, licensee did not submit written reports to licensing to 1 of 80 residents. This posed a potential health and safety risk to residents in care.

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Deficiency Dismissed
Type B
07/28/2023
Section Cited
CCR
87468.1(a)(3)
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Personal Rights of Residents in All Facilities (a)Residents …shall have all the following personal rights: (3) To be free from… intimidation, abuse, or other actions of a punitive nature…

This requirement was not met as evidenced by:

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CBD and RSD have agreed to have all care staff and management attend a training regarding resident rights by a CCL approved vendorized agency. CBD and RSD will provide proof of completion by all staff by POC due date.
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Based on interviews, staff spoke in an intimidating manner to (add #) of 80 residents. This posed a potential personal rights risk to residents in care.

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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 JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 05/31/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2023
LIC9099 (FAS) - (06/04)
Page: 8 of 11
Control Number 08-AS-20230328090405
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
07/28/2023
Section Cited
CCR
87465(h)(2)
1
2
3
4
5
6
7
Incidental Medical and Dental Care
(h)(2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible…

This requirement was not met as evidenced by:
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2
3
4
5
6
7
CBD and RSD will have all care staff attend a training regarding medication management by a CCL approved vendorized agency. CBD and RSD will also implement an internal auditing system to ensure medications are tracked and secured by staff.

CBD Maezza will provide proof of completion by all staff by POC due date.
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14
Based on interviews and observations, facility did not keep medications in safe and locked place. This posed a potential safety risk to 4 of 80 residents in care.
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Deficiency Dismissed
Type B
07/28/2023
Section Cited
CCR
87411(c)
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3
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5
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7
Personnel Requirements – General
(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training

This requirement was not met as evidence by:
.

This requirement was not met as evidenced by:
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2
3
4
5
6
7
CBD and RSD will coordinate a training tracking system to ensure all required training hours and topics (based on title) are complete prior to all new hires being assigned/scheduled shifts.

CBD and RSD will provide proof of completion by POC due date.
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14
Based on record reviews and interviews, staff did not receive initial training.

This posed a potential health risk to residents in care.
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9
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14
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 JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

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

DATE: 06/06/2023
LIC9099 (FAS) - (06/04)
Page: 9 of 11
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
03/28/2023 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20230328090405

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: 85DATE:
06/06/2023
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Community Business Director (CDB) Maritza Maezza TIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
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5
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9
Staff worked under the influence of Marijuana.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to deliver investigative findings on the above listed complaint allegation. LPA Correia met with Community Business Director (CDB) Maritza Maezza to whom was explained the purpose for the visit.

The Department’s investigation consisted of staff and outside source interviews as well as outside source and clients records reviews.

Due to lack of 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 CBD Maezza. At the time of the exit interview CBD Maezza and MD 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.
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: 06/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023
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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