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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 04/25/2025
Date Signed: 04/25/2025 04:42:34 PM

Substantiated


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
06/22/2023 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230622123846
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: 95DATE:
04/25/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Executive Director Julia LopezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee coerced resident to sign documents
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to deliver findings in the above-mentioned allegation. LPA met with Executive Director Julia Lopez and discussed the purpose of the visit.

On June 22, 2023, Community Care Licensing (CCL) received a complaint alleging Licensee coerced Resident 1 (R1) to sign documents. According to R1's Physician Report dated January, 2023, R1 is able to communicate needs.

During investigation, LPA Strong collected pertinent resident records as well as facility documentation and conducted interviews. According to the allegation, Resident 1 (R1) was forced to sign a document agreeing to a higher level of care. Interview with R1 revealed that R1 was told by Staff 1 to sign the document to continue receiving assistance with activities of daily living.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
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 5
Control Number 08-AS-20230622123846
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: 04/25/2025
NARRATIVE
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Resident Functional Need Assessment Document signed February 6, 2023, collected from R1’s file, shows R1’s signature along with the words “under duress” on the documents signature line. Interview with an outside source confirmed that R1 communicated being forced to sign document R1 did not agree with. Interview with Executive Director revealed they were unaware of this incident and S1 is no longer present at the facility.

Based on interviews, and records reviewed, a preponderance of evidence exists to support the allegations. Deficiencies are being cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted with Executive Director Julia Lopez, to whom a copy of this report, LIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20230622123846
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/25/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2025
Section Cited
CCR
87468.1(a)(3)
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(a) Residents shall have all of the following personal rights:...(3)To be free from intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.
This requirement was not met:
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ED states S1 is no longer present and states they will provide a signed statement on how refusal of signatures are handled.
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Based on records reviewed the licensee intimidated 1 of 88 persons in care (R1]) into signing documents which posed a potential Personal Rights risk to persons 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.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
06/22/2023 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20230622123846

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: 95DATE:
04/25/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Executive Director Julia LopezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Licensee took resident's personal items
Unlawful eviction
Licensee did not conduct a proper reassessment
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced complaint visit to deliver findings on the above-mentioned allegations. LPA met Executive Director Julia Lopez and discussed the purpose of the visit.

On June 22, 2023, Community Care Licensing (CCL) received a complaint alleging Licensee took Resident 1’s personal items, an unlawful eviction was issues to R1 and Licensee did not conduct a proper reassessment of R1.

According to the allegation, on an undisclosed date, when R1 was away from their room, R1’s cellular phone was stolen form their room by Staff 1 (S1). Interview with R1 revealed that they called the cellular phone, and an unknown woman answered but was unable to retrieve the phone. During interview, S1 stated they did not take the cellular phone. Interview with an outside source could not confirm that R1’s cell phone was stolen or lost.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 08-AS-20230622123846
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: 04/25/2025
NARRATIVE
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It was also alleged that R1 was issued an unlawful eviction. Records collected established that R1 was issued an eviction notice for a past due balance. R1 stated that they were aware of the balance due and had not issued payment. Outside source established that R1 was past due on balance due to increase in care needs.

Lastly, it was alleged that R1 was not properly reassessed by licensee. Records collected revealed that R1 had a change in condition in January of 2023, which resulted in multiple falls and increased hospital visits. Interviews with staff revealed that R1’s health was declining and needed more assistance, therefore a new care plan was created. Interview with R1 established that R1 was reassessed using information from medical providers. Interview with Executive Director revealed that using medical information and interviewing medical providers is a standard practice for reassessments.

Based on interviews, and record reviews there is not a preponderance of evidence to prove alleged violations occurred, therefore the allegations are unsubstantiated. An exit interview was conducted with Executive Director Julia Lopez, to whom a copy of this report, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 04/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5