374600890-5-7-2025-08-AS-RCLK-DH85SX-20250531201327

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 05/07/2025
Date Signed: 05/07/2025 11:17:09 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
11/05/2024 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20241105124844

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: 94	DATE:	05/07/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Maintenance Director Omar Zamudio		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff are not addressing mold at facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced visit to deliver investigative findings on the above complaint allegation. The LPA introduced himself and disclosed the purpose of the visit to Maintenance Director Omar Zamudio.

The Department’s investigation included staff and resident interviews, a review of facility records, facility tour, and secured photos.

On November 5, 2024, the Department received a complaint alleging facility staff did not address mold at the facility. Specifically, Resident1 (R1) revealed there was mold in their room. An interview with R1 revealed the facility staff had placed buckets in the hallways to catch water that leaked through the roof from recent rain (exact date unknown). and the leak caused mold to grow around their air conditioner (AC) unit. An interview with the Executive Director was not aware of mold issues or roof leaks at the facility.

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

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-20241105124844

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: 05/07/2025

NARRATIVE

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An additional interview conducted with Staff1 (S1) revealed the residue around R1’s AC unit was not mold but dirt that accumulated from the unit’s air filtration system, and this is typical for all ACs. At the time of LPA’s visit R1 had recently moved out of the facility and their room was vacant and had not yet been cleaned. LPA inspected R1’s room and observed the AC unit had a dark film around the air vent slats. LPA was able to easily wipe the film off. During the tour LPA observed other resident’s rooms and their AC units that were consistent with S1’s statement about the AC filtration system.

A review of facility records included a log of all maintenance requests made by residents between October 15, 2024, and November 14, 2024, revealed 82 maintenance requests were submitted by residents but not one of them was made by R1, nor were there requests made by any residents regarding issues with mold or flooding at the facility. Interviews conducted with residents that resided at the facility during the time the complaint was lodged revealed no issues with mold in their room or the facility in general, nor any knowledge of leaks that occurred at the facility.

Based on the investigation the allegation was determined to be Unsubstantiated. An Unsubstantiated finding means although the allegation could be valid the preponderance was not met to support the violation occurred.

An exit interview was conducted with Zamudio, to whom a copy of this report, and Licensee Rights (LIC 9058), were provided. Signatures below confirms receipt of the reports.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC9099 (FAS) - (06/04)

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