374600890-5-9-2024-08-AS-LTEZ-D5KRPV-20240524131234

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 05/09/2024
Date Signed: 05/09/2024 01:27:56 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 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
03/29/2024 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20240329084536

FACILITY NAME:	ATRIA COLLWOOD		FACILITY NUMBER:	374600890
ADMINISTRATOR:	JULIA LOPEZ		FACILITY TYPE:	740
ADDRESS:	5308 MONROE AVE		TELEPHONE:	(619) 286-3583
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	185	CENSUS: 87	DATE:	05/09/2024
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Executive Director Julia Lopez		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not meet a resident's needs

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced follow up complaint investigation visit, and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Julia Lopez.

Throughout the investigation, the Department secured pertinent records and conducted interviews with external and internal sources.

It was alleged staff did not meet a resident's needs. On 3/29/24, it was reported to the Department Resident # 1 (R1) asked staff to escort R1 to R1’s room, but staff was not available to assist with the escort.

Review of records, including care plans, assessments, pre-appraisal, and invoices for services, revealed the following information.
(See LIC 9099C for continuation of report.)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

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-20240329084536

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ATRIA COLLWOOD	FACILITY NUMBER: 374600890
	VISIT DATE: 05/09/2024

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

R1 was able to ambulate by walking on her own and using a wheelchair on some occasions. A Physician’s Report, interviews with internal and external sources and an observation by the LPA, confirmed R1 was able to ambulate by walking, or using a wheelchair.

Initial care plans noted R1 was receiving and being charged for escorting services. Additional care plans and invoices, along with an interview of the administrator, revealed R1 declined the continuation of escorting services due to the additional charge. The facility administrator agreed to remove the charge and service, as R1’s assessments did not indicate a need for such service.

Interviews with internal and external sources, including the alleged staff that was present, did not report any concerns regarding lack of assistance from staff. Review of R1’s account history revealed the facility had begun to only charge for basic services, not including escorts or other care, since September of 2023.
Based on the evidence obtained, there was not enough evidence to prove the alleged violation occurred, therefore, the allegation was Unsubstantiated.

An exit interview was conducted with Executive Director Lopez, and Maintenance Director Omar Zamudio, to whom a copy of this report, LIC 811 Confidential names list, and Licensee/Appeals Rights (LIC 9058), were provided.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel Martinez	TELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 05/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/09/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2