374600890-2-16-2023-08-AS-LTEZ-CPGU8B-20230228142117

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 02/16/2023
Date Signed: 02/16/2023 03:29:32 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/17/2021 and conducted by Evaluator Dawn Segura

COMPLAINT CONTROL NUMBER: 08-AS-20211117163255

FACILITY NAME:	ATRIA COLLWOOD		FACILITY NUMBER:	374600890
ADMINISTRATOR:	ARTEAGA, IRMA		FACILITY TYPE:	740
ADDRESS:	5308 MONROE AVE		TELEPHONE:	(619) 286-3583
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92115
CAPACITY:	185	CENSUS: 80	DATE:	02/16/2023
		UNANNOUNCED	TIME BEGAN:	03:10 PM
MET WITH:	Julia Lopez, Executive Director		TIME COMPLETED:	03:35 PM

ALLEGATION(S):

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Licensee did not assist resident in obtaining medical and dental care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Dawn Segura conducted a visit to conclude a complaint investigation. LPA was granted entry into the facility and met with Julia Lopez, Executive Director, to whom she disclosed the purpose of the visit.

Community Care Licensing (CCL) has investigated the above listed complaint allegation. The investigation consisted of a review of facility records and interviews with facility residents, staff, and outside source.

It was alleged that the facility did not assist Resident 1 (R1) with obtaining medical and dental care. It was reported that R1 had not seen a doctor, dentist, or optometrist in three years. LPA discovered during the investigation that toward the end of R1’s time in the facility, R1 had been assessed and diagnosed with having dementia. Following the diagnosis of dementia, R1 moved out of the facility and into a facility that could provide a higher level of care. Evidence obtained during the investigation revealed that, prior to the dementia diagnosis, from the time of R1’s admission, while residing in the facility, R1 was primarily

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

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-20211117163255

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ATRIA COLLWOOD	FACILITY NUMBER: 374600890
	VISIT DATE: 02/16/2023

NARRATIVE

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independent in self-care and managed arrangement of his/her own appointments. Interview conducted during the investigation yielded that, prior to R1’s relocation from the facility, R1 was regularly seen by physicians and was regularly provided medical and dental care to meet his/her needs. The investigation did not yield evidence to corroborate the allegation.

Based upon the foregoing and lack of evidence to indicate otherwise, the allegation is unsubstantiated. This finding means that although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Julia Lopez, Executive Director, and copies of this report and Licensee/Appeal Rights (LIC 9058) were provided to the Executive Director at the conclusion of the visit. Her signature on this form acknowledges receipt of copies of the rights and this report.

SUPERVISOR'S NAME: Lizzette Tellez	TELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dawn Segura	TELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:	DATE: 02/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2023

LIC9099 (FAS) - (06/04)

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