374600890-3-26-2026-08-AS-SJAB-DSQSGK-20260401135203

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 03/26/2026
Date Signed: 03/26/2026 06:53:59 PM

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
03/25/2026 and conducted by Evaluator Dang Nguyen

COMPLAINT CONTROL NUMBER: 08-AS-20260325112312

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:	DATE:	03/26/2026
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Receptionist Tessa Randolph and Engage Life Director Naomie Peterson		TIME COMPLETED:	07:00 PM

ALLEGATION(S):

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Licensee pursued unlawful eviction of resident.

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 Receptionist Tessa Randolph. LPA then met with Engage Life Director Naomie Peterson.

The Complainant alleged that Licensee pursued an unlawful eviction of Resident #1 (R1). [See LIC811 Confidential Names List for a description of R1.] CCLD’s investigation involved an unannounced facility tour/welfare check and interviews of pertinent residents, facility staff, and outside sources. The Department also reviewed relevant care records and monthly billing statements.

[CONTINUED ON LIC 9099-C]

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

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-20260325112312

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: 03/26/2026

NARRATIVE

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[CONTINUED FROM LIC 9099]

Records and interviews aligned to show: On 03/11/2026, Licensee served R1 with an eviction letter citing nonpayment of rent and fees. The effective date of the eviction listed in this letter was 04/24/2026, which was more than the required thirty (30) day minimum. The dollar amount demanded in this letter accurately represented the portion of the balance which R1 owed to Licensee, and which was also more than ten (10) days past due. The letter also contained the required text disclosures described in regulations, as far as the spirit of the law is concerned.

Interviews of R1 and staff, corroborated by LPA observation, aligned to showed: During the pertinent review period, R1 received help in practice from facility direct care staff with medication storage and administration, and with emptying and managing their urinary catheter. Licensee assessed and billed R1 at the care and medication levels corresponding to practice. Prior to the issuance of the 03/11/2026 eviction letter, Licensee had made multiple attempts to communicate with R1’s Responsible Person (RP) to resolve R1’s past due balance, but the problem was not solved. As of the commencement of CCLD’s investigation, Licensee had not received any payment on R1’s account for the preceding two (2) months, and R1’s past due balance was actively growing.

Based on records and interviews, a preponderance of evidence does not exist to show that Licensee pursued an unlawful eviction of R1. The allegation is therefore Unsubstantiated, and no deficiency was cited for it. LPA issued one (1) Technical Violation regarding letter formatting (refer to the LIC9102-TV page) and provided Technical Assistance (TA) regarding promoting a resident’s independence.

An exit interview was conducted with Engage Life Director Naomie Peterson, to whom a copy of this report, the LIC9102-TV page, the LIC9102-TA page, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC9099 (FAS) - (06/04)

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