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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600890
Report Date: 08/29/2024
Date Signed: 08/30/2024 08:43:21 AM


Document Has Been Signed on 08/30/2024 08:43 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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



FACILITY NAME:ATRIA COLLWOODFACILITY NUMBER:
374600890
ADMINISTRATOR:JULIA LOPEZFACILITY TYPE:
740
ADDRESS:5308 MONROE AVETELEPHONE:
(619) 286-3583
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY:185CENSUS: 96DATE:
08/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Executive Director (ED) Julia LopezTIME COMPLETED:
01:50 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced case management visit at the facility. LPA gained access to the facility, identified herself, and met with Executive Director (ED) Julia Lopez to whom was explained the purpose of the visit.

During today's visit LPA conducted staff and resident interviews and secured records.

Today's visit was in response to a Special Incident Report (SIR) received on August 25, 2024, by Community Care Licensing (CCL) regarding an incident that involved Resident 1 (R1) eloping from the facility on the prior day, August 24, 2024. A review of facility records revealed on August 24, 2024, R1 left the facility at approximately 11:15 AM and was found by a neighbor on the community corner who who activated 911 and R1 was picked by the local police department and brought to a family member's home who brought R1 back to the facility at approximately 9:00 PM. [See LIC 811 for confidential names]

No deficiencies were cited during today's visit. LPA notified ED Lopez follow up visits and or phone calls are necessary before a determination if a violation had occurred. An exit interview was conducted with ED Julia Lopez and a copy of this report and Licensee/Appeal Rights (LIC9058 01/16) were provided at the conclusion of the visit. Signature below confirms receipt of the reports.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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