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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600890
Report Date: 09/25/2024
Date Signed: 09/25/2024 01:29:37 PM


Document Has Been Signed on 09/25/2024 01:29 PM - 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: 97DATE:
09/25/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Driver John RodriguezTIME COMPLETED:
11:45 AM
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Licensing Program Manager (LPA) Debbie Correia conducted an unannounced case management visit to obtain signatures, and deliver two (2) amended reports. LPA identified herself to, and met with Driver John Rodriguez to whom was explained the purpose of the visit.

During the visit, LPA delivered on two (2) amended version of reports originally delivered on September 19, 2024, and obtained signatures.

An exit interview was conducted with Driver Rodriguez and copies of this report and Licensee Rights (LIC 9058 01/16) were provided at the conclusion of the visit. Their signature on this form acknowledges receipt of the rights and a copy of this report.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2024
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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