374600890-5-20-2024-08-AS-SJAB-D5HV6S-20240522161000

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 05/17/2024
Date Signed: 05/20/2024 10:16:24 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
01/23/2024 and conducted by Evaluator Amy Domingo

COMPLAINT CONTROL NUMBER: 08-AS-20240123162901

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: 88	DATE:	05/17/2024
		UNANNOUNCED	TIME BEGAN:	08:13 AM
MET WITH:	Omar Zamudio Maintenance Director		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility Plumbing is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Amy Domingo conducted an unannounced visit to deliver findings in the above complaint allegation. LPA identified herself and discussed the purpose of the visit with Maintenance Director Omar Zamudio.

On January 23, 2024 Community Care Licensing (CCL) received a complaint alleging the facility plumbing is disrepair. During the investigation, LPA Domingo conducted a facility inspection, collected pertinent records, and conducted interviews.

According to allegation received, Resident 1 (R1), (Please refer to LIC811 confidential names list), stated that the facility had no running water to wash resident hands after using the restroom. R1 was interviewed and R1 stated that the facility has poor plumbing. R1 was unable to provide dates of when R1 encountered the poor plumbing except for January 23, 2024. R1 stated that there was not any running water in R1's bathroom to wash R1's hands after using the bathroom. R1 was asked if an alternative room was made available and R1 was unable to recall but stated that R1

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

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-20240123162901

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: 05/17/2024

NARRATIVE

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Continued from LIC9099

On January 31, 2024 LPA Domingo interviewed Staff 1 (S1) and S1 provided information regarding plumbing repairs that were completed on January 23, 2024. S1 stated that an alternative bathroom was provided for residents that needed repairs in their rooms. S1 stated that the repairs were completed on the same day that the plumbing needed repairs.

Outside Source 1 (OS1) was interviewed and stated that OS1 was aware of the repairs that were needed to resident rooms that the plumbers were working on. OS1 stated that there were rooms available that had no plumbing issues for residents to temporarily use until the repairs were completed. Resident 2 (R2) was interviewed and had no complaints or concerns regarding the plumbing issue that occurred on January 23, 2024. R2 stated that the management made the residents aware of the repairs and provided alternative rooms, including bathrooms for residents to utilize during the repairs. Resident 3 (R3) was interviewed and R3 stated that the management informed the residents of the repairs and provided alternative rooms and bathrooms to use during the repairs.

Based on interviews, LPA observations and records review, a preponderance of evidence does not exist to prove that the alleged violation occurred, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Maintenance Director Omar Zamudio, to whom a copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISOR'S NAME: Simon Jacob	TELEPHONE: (619) -76-2306
LICENSING EVALUATOR NAME: Amy Domingo	TELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:	DATE: 05/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024

LIC9099 (FAS) - (06/04)

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