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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600890
Report Date: 12/21/2021
Date Signed: 12/22/2021 08:39:28 AM

Document Has Been Signed on 12/22/2021 08:39 AM - It Cannot Be Edited

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 COLLWOODFACILITY NUMBER:
374600890
ADMINISTRATOR:ARTEAGA, IRMAFACILITY TYPE:
740
ADDRESS:5308 MONROE AVETELEPHONE:
(619) 286-3583
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY: 185CENSUS: 94DATE:
12/21/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Regional Vice President Julie WieseTIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced subsequent case management visit to cite a deficiency identified during a prior-opened investigation. LPA was greeted by and identified himself to receptionist Karen Eugene. LPA then met and discussed the purpose of the visit with Regional Vice President Julie Wiese.

On April 7th, 2021, licensee self-reported an incident about alleged inappropriate sexual comments and touching perpetrated by Staff Member 1 (S1) against Resident 1 (R1) on April 5th, 2021. [See attached LIC 811 Confidential Names list for a description of S1.] Licensee immediately notified CCLD, the San Diego Police Department (SDPD), and the San Diego County Long-Term Care Ombudsman, and suspended S1’s employment pending further investigation. CCLD’s investigation consisted of a review of pertinent resident, staff, and police records, as well as interviews of R1, staff, and outside sources. It was determined that S1 engaged in sexual harassment towards a resident in care.

According to interviews of R1: On the afternoon of April 5th, 2021, S1 entered R1’s private bedroom to deliver a package. R1 was wearing a dress, sitting in a chair with legs crossed. S1 sat on the seat of R1’s walker, then asked R1, “When was the last time you had sex?” and “Have you had sex since being here?” R1 stated their discomfort and made it known that the questions were not welcome. S1 later placed their hand on R1’s left leg without provocation. S1 tried to part R1’s crossed legs, under the premise of wanting to see how mobile R1’s legs were. R1 repeatedly told S1 to stop, before R1 ceased. R1 feared S1 would have forced sex upon them had they been weaker. The following morning, R1 saw S1 near the facility entrance, and confronted them about their behavior. S1 replied, “Are you going to tell on me?”

[CONTINUED ON LIC 809-C, 1 of 2]

SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 12/21/2021
NARRATIVE
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[CONTINUED FROM LIC 809]

S1 was interviewed on two occasions (once by CCLD, and once by an SDPD detective). S1 consistently stated they entered R1’s private bedroom to deliver a package. R1 was sitting in a chair. They conversed about S1’s girlfriend and about dancing. S1 wanted to see if R1 was still “flexible,” so S1 took it upon themselves to grab R1’s leg with both hands and try to move R1’s feet apart. R1 repeatedly told S1 to stop, but S1 did not immediately hear this. S1 stopped, and recognized their actions were “stupid” and made R1 “uncomfortable.” S1 corroborated that on a morning following the incident, R1 confronted them about their behavior being unwelcome.

R1’s recollection of the incident to the facility administrator and multiple peace officers told a consistent narrative. LPA’s observations, interviews of staff, and review of facility records all corroborated that R1 had no cognitive impairment, either at the time of the alleged incident or during the ensuing investigation. R1’s LIC602 Physician’s Report confirmed they were neither confused or disoriented, that they required no assistance with dressing or toileting, and were able to follow instructions, able to communicate needs, and even able to manage their own finances and medications.

S1 impaired their credibility: 1) S1 told CCLD that they did not ask R1 questions about sex. However, S1 told SDPD that they asked R1 if they were sexually active; 2) S1 was a bus driver and their job did not involve loitering in resident rooms or touching residents behind closed doors, yet S1 did both to R1; 3) As admitted to CCLD and SDPD, S1 quickly recognized their touching R1’s legs made R1 “uncomfortable” (discomfort so enduring that R1 personally confronted S1 about the incident on a subsequent day), yet S1 did not report the incident to their supervisor or to the Long Term-Care Ombudsman (S1 was a Mandated Reporter).

[CONTINUED ON LIC 809-C, 2 of 2]

SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 12/21/2021
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[CONTINUED FROM LIC 809-C, 1 of 2]

According to facility records and interview of the then-administrator, on April 13th, 2021, licensee terminated S1’s employment for “violation of Atria’s policy on resident abuse.” On May 19th, 2021, SDPD concluded of S1’s involvement in the incident, “All the necessary elements of the offense [California Penal Code Section 242 Battery] are present.” The preponderance of evidence shows that S1’s speech and actions caused a dependent adult in care to feel violated inside their own home.

S1 was an agent of the licensee during the above violation, which also occurred on facility premises. Based on records and interviews, a deficiency is being cited per California Code of Regulations, Title 22; see attached LIC 809-D. A plan of correction was jointly developed with Wiese and an exit interview was conducted. A copy of this report, the LIC 811 Confidential Names list, and the Licensee/Appeal Rights (LIC9058 01/16) were provided via E-mail.

SUPERVISORS NAME: Rebecca Hedgecock
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 12/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/21/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 12/22/2021 08:39 AM - It Cannot Be Edited


Created By: Dang Nguyen On 12/21/2021 at 10:53 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ATRIA COLLWOOD
FACILITY NUMBER: 374600890

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/20/2022
Section Cited
CCR
87468.2(a)(1)

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Personal Rights of Residents in All Facilities: “Residents in all residential care facilities shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons.”
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Since S1’s employment was terminated as of April 13th, 2021, the immediate threat was removed. Licensee shall retrain current employees on Abuse and Neglect Prevention, Sexual Harassment, Mandated Reporting, Resident Rights, and prohibition of staff-and-resident romantic and sexual relations. Licensee shall submit training agenda and sign-in sheet(s) to LPA by the POC due date.
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Based on records and interviews, Licensee’s staff, through sexual harassment, violated the dignity of 1 resident [R1] of 96 in care, which posed an immediate personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Rebecca Hedgecock
LICENSING EVALUATOR NAME:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 12/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/21/2021


LIC809 (FAS) - (06/04)
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