374600890-12-18-2024-08-AS-LTEZ-DCG3AF-20241230170440

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 12/17/2024
Date Signed: 12/18/2024 10:38:22 AM

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
09/18/2024 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20240918091515

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: 96	DATE:	12/17/2024
		UNANNOUNCED	TIME BEGAN:	01:25 PM
MET WITH:	Executive Director Julia Lopez		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff did not provide a comfortable environment

INVESTIGATION FINDINGS:

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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 records and conducted interviews with external and internal sources, including staff and residents.

It was alleged staff did not provide a comfortable environment. On 09/18/2024, it was reported to the Department Resident # 1 (R1) yelled and slammed a door causing a resident to not feel comfortable at the facility. It was also reported the gardening crew had conducted gardening work in the early morning hours, therefore, making a resident not feel comfortable.

(See LIC 9099-C for continuation of report.)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

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-20240918091515

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: 12/17/2024

NARRATIVE

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Interviews with multiple residents residing in the vicinity of R1 did not recall any similar incidents, nor concerns with R1. These residents recalled the gardening crew working in the area but did not have any concerns and mentioned feeling comfortable in their bedrooms. Interviews with several staff members did not recall any similar behaviors from R1 and did not recall other residents reporting any concerns. These staff did not recall receiving any complaints from residents regarding the gardening crew’s work disturbing the residents.

An interview with Executive Director Lopez revealed there was an instance when R1 became upset a smoke alarm battery was low and kept chirping. The LPA attempted to interview the staff who was present during this incident on multiple occasions, but the LPA was not successful. An interview with the local Long Term Care Ombudsman office did not reveal any knowledge, nor concerns with R1, nor with the gardening crew disturbing the residents.

Based on the information revealed during the investigation, 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, to whom a copy of this report, LIC 811, and Licensee/Appeals Rights (LIC 9058), were provided via email. An email read receipt confirms the documents were received by Lopez.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 12/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024

LIC9099 (FAS) - (06/04)

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