374600890-1-20-2026-08-AS-SJAB-DQTW4E-20260130155727

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 01/20/2026
Date Signed: 01/20/2026 04:34:49 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
01/12/2026 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20260112145952

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: 88	DATE:	01/20/2026
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Resident Services Director Ashley Baino-Jaimes		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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-Licensee did not provide needed level of care to resident.
-Licensee did not ensure resident’s room was safe and healthful.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced visit to commence a Complaint Investigation regarding the above allegations. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Resident Services Director Ashley Baino-Jaimes.

The Complainants alleged that Licensee did not provide the needed level of care to Resident #1 (R1) and that Licensee did not ensure R1’s room was safe and healthful. [See LIC811 Confidential Names List for a description of R1.] CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of R1 and relevant staff and outside sources. The Department also reviewed pertinent care and administrative records.

[CONTINUED ON LIC 9099-C, 1 of 2]

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026

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 4

Control Number 08-AS-20260112145952

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: 01/20/2026

NARRATIVE

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[CONTINUED FROM LIC 9099]

The Complainants said between September 2025 and the filing date of the complaint (01/12/2026), R1 in practice needed help with mobility/transferring, personal hygiene tasks, and managing medical appointments, but facility staff were not consistently providing R1 this needed help. They also said R1’s room was malodorous and messy/cluttered, to include potential tripping hazards on the floor.

Review of R1’s care records showed R1 diagnoses included Schizoaffective Disorder and Congestive Heart Failure. During his own 01/20/2026 site visit, LPA met and interviewed R1 inside their private apartment. R1’s room was malodorous with a strong fecal smell. LPA observed R1 did not flush their toilet after a bowel movement, and there was fecal staining around R1’s toilet seat, on the outside of R1’s toilet bowl, on R1’s bathroom floor, and on the carpet of R1’s bedroom. While R1’s clothes were clean during this visit, R1’s hair was dirty/unkempt, and their facial hair was about an inch-long and messy. While R1 was reluctant to pay more money for a higher level of care, R1 statements to LPA also revealed that they currently needed 1-Person Assistance from staff with Mobility/Transferring, Dressing, Grooming, Bathing, Bathroom Assistance, Status Checks, Medication Management, and Daily Housekeeping.

Interview of facility management, corroborated by R1’s facility care records, showed: When R1 first moved-in on 11/13/2020, Licensee assessed R1 as then needing help with Transferring (Minimal Assist), Bathing (Standby Assist Once Per Week), Status Checks (Three Times Per Day), Medication Assistance, and Once-Per-Week Housekeeping, and Licensee prepared R1’s care plan accordingly. Then on 03/03/2021, Licensee reassessed R1, determining R1 now needed zero help with personal care tasks or status checks, beyond Medication Assistance and Once-Per-Week Housekeeping, and Licensee updated R1’s care plan accordingly. Then on 09/22/2025, Licensee again reassessed R1, determining R1 now needed help with Status Checks (Three Times Per Day), Medication Assistance, and Once-Per-Week Housekeeping, and Licensee updated R1’s care plan accordingly. Then on 01/19/2026, Licensee again reassessed R1, determining R1 now needed help with Mobility/Escorting (Limited), Bathing (Standby Assist Twice Per Week), Status Checks (3 Times Per Day), Medication Assistance, and Daily Housekeeping, and Licensee updated R1’s Care Plan accordingly.

[CONTINUED ON LIC 9099-C, 2 of 2]

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 08-AS-20260112145952

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: 01/20/2026

NARRATIVE

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[CONTINUED FROM LIC 9099-C, 1 of 2]

CCLD received the complaint on 01/12/2026. While Licensee reassessed R1’s care needs as recently 01/19/2026, the level of care that Licensee determined still fell short of R1’s true, current care needs. Interviews of facility management and multiple visiting outside medical professionals (who were assigned to R1) showed that during the complaint timeframe, Licensee did not provide the level of hygiene care that R1 actually needed. Interviews showed Licensee did connect R1 to professional organizers/movers and a storage unit to reduce the clutter in R1’s bedroom during the complaint time frame. However, during LPA’s own 01/20/2026 visit, he saw multiple objects still on R1’s bedroom floor which were potential slip/trip hazards. Interview of R1 and manager, corroborated by past self-submitted LIC624 Incident Reports received at CCLD from Licensee, showed R1 had a history of falls. [During today's visit, LPA directed Licensee’s staff to provide immediate housekeeping services for R1's bedroom.] Per interview of facility management, Licensee is currently assisting R1 with managing their medical appointments.

Based on records and interviews, a preponderance of evidence exists to show that at least during the complaint time frame, Licensee did not provide the needed level of care to R1 and that Licensee did not ensure R1’s room was safe and healthful. Both allegations are therefore Substantiated. Two (2) deficiencies were cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D page). Plans of Correction were jointly developed with the Licensee.

An exit interview was conducted with Resident Services Director Ashley Baino-Jaimes, to whom a copy of this report, the LIC 9099-D page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided. A duplicate set of these same documents was E-mailed to Executive Director Julia Lopez.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 08-AS-20260112145952

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: 01/20/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/20/2026 Section Cited CCR 87464(f)(4)	1 2 3 4 5 6 7	87464 Basic Services: “(f) Basic services shall at a minimum include: (4) Personal assistance and care as needed by the resident…with those activities of daily living such as dressing, eating, bathing…” This requirement was not met, as evidenced by:	1 2 3 4 5 6 7	During today’s visit, Licensee performed a written reappraisal of R1’s care needs and updated R1’s care plan, with the effect that R1 will receive staff assistance with Mobility/Escorting, Transferring, Dressing, Grooming, Bathing (Standby Assist Twice Per week), Bathroom Assistance, Status Checks (3 Times Per day), Medication Assistance, and Daily Housekeeping. The Plan of Correction is Satisfied.
	8 9 10 11 12 13 14	Based on LPA observation, records, and interviews: Licensee did not provide all personal assistance and care that was needed by 1 of 88 residents (R1), which posed a potential health and personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 01/20/2026 Section Cited CCR 87307(d)(2)	1 2 3 4 5 6 7	87307 Personal Accommodations and Services: “(d) The following space and safety provisions shall apply to all facilities: (2) The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.” This requirement was not met, as evidenced by:	1 2 3 4 5 6 7	During today’s visit, Licensee agreed to immediately deep clean R1’s bedroom carpet, bathroom floor, and toilet, and to perform thorough housekeeping in R1’s bedroom. R1’s current care plan already has them set up on daily housekeeping services. The Plan of Correction is Satisfied.
	8 9 10 11 12 13 14	Based on LPA observation and interviews, Licensee did not provide a safe and healthful environment to 1 of 88 residents (R1), which posed a potential health, safety, and personal rights risk to persons in care.	8 9 10 11 12 13 14

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: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 01/20/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/20/2026

LIC9099 (FAS) - (06/04)

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