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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600890
Report Date: 01/02/2025
Date Signed: 01/05/2025 08:35:03 PM

Document Has Been Signed on 01/05/2025 08:35 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/
DIRECTOR:		JULIA LOPEZFACILITY TYPE:
740
ADDRESS:5308 MONROE AVETELEPHONE:
(619) 286-3583
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY: 185CENSUS: 97DATE:
01/02/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Executive Director (ED)Julia Lopez and Resident Service Director (RSD) Ashley Baino-JaimesTIME VISIT/
INSPECTION COMPLETED:
06:25 PM
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Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to conduct a Case Management visit regarding a Death Report by the Department LPA was greeted by Front Lobbyist Griselda Pacheco, identified herself, then met with Executive Director (ED) Lopez and Resident Service Director (RSD) Baino-Jaimes to whom was explained the purpose of the visit.

Today's visit was in response to a Death Report received on December 30, 2024 by Community Care Licensing (CCL) regarding Resident1 (R1). LPA conducted a resident records request and interviewed staff. [See LIC 811 for confidential names].

No deficiencies were cited during today's visit. LPA notified RSD Baino-Jaimes follow up visits and or phone calls are necessary before a determination if a violation had occurred. An exit interview was conducted with RSD Baino-Jaimes and a copy of this report and Licensee/Appeal Rights (LIC9058 01/16) will be provided at the conclusion of the visit. Signature below confirms receipt of the report.

LPA left to conduct other time sensitive work related visits during today's Case Management visit.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 01/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/02/2025
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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