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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603456
Report Date: 09/17/2021
Date Signed: 09/17/2021 05:30:11 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ATRIA NORTH ESCONDIDOFACILITY NUMBER:
374603456
ADMINISTRATOR:MITCHELL, KATHLEENFACILITY TYPE:
740
ADDRESS:1342 N ESCONDIDO BLVDTELEPHONE:
(760) 480-8155
CITY:ESCONDIDOSTATE: CAZIP CODE:
92026
CAPACITY:101CENSUS: 86DATE:
09/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Cathy Kintz, Engaged Life DirectorTIME COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Carmen Lopez conducted a Case Management visit, to conduct an unannounced health and safety check for clients in care. LPA identified herself and was granted entry by Adriana Morales, Concierge. LPA met with Cathy Kintz, Engaged Life Director and disclosed the purpose of the visit.

During today's visit, LPA spoke with staff and client, and requested and obtained pertinent documents maintained by the facility. No immediate health or safety concerns were observed. No deficiencies were observed or cited during today’s visit.

An exit interview was conducted with Cathy Kintz, Engaged Life Director and a copy of the report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Engaged Life Director Kintz via email. An electronic email receipt confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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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