374600890-9-26-2024-08-AS-SJAB-D9LLG4-20240930084405

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 09/26/2024
Date Signed: 09/26/2024 11:16:52 AM

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
06/27/2024 and conducted by Evaluator Ramon Serrano

COMPLAINT CONTROL NUMBER: 08-AS-20240627112813

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: 97	DATE:	09/26/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Julia Lopez		TIME COMPLETED:	11:29 AM

ALLEGATION(S):

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Staff did not provide a comfortable environment for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ramon Serrano conducted an unannounced complaint visit to deliver findings on the above allegation. LPA met with Executive Director Julia Lopez and we discussed the purpose of the visit and elements of the complaint.

Community Care Licensing (CCL) has investigated the above allegation. The investigation consisted of LPA observation, records review and interviews with facility staff, residents and outside sources.

It was alleged that the facility did not provide a comfortable environment for Resident 1 (R1) (an LIC 811 Confidential Names List was provided to the facility representative to identify the residents.) Specifically, it was reported that Resident 2 (R2) entered R1's room, causing distress.

LPA interviewed R1 who stated that some "new person" that recently moved into the facility walked into R1's room.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

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-20240627112813

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: 09/26/2024

NARRATIVE

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R1 stated that R2 should not be living there since R2 has "dementia." R1 stated that R2 entered R1's room which R1 usually keeps unlocked. R1 stated that R1 yelled from R1's bed "who is it" and R2 responded. R1 stated that R2 is completely "out of it."

LPA interviewed R2 who stated that R2 recently moved into the facility and is still unfamiliar with the facility layout. R2 acknowledged having walked towards R1's room due to confusion over room numbers. R2 indicated that the door was slightly open, and R2 called out, but did not actually enter the room. R2 clarified that all interactions occurred at the door entrance.

LPA reviewed R2's physician's report which indicated that R2's overall health was fair. Physician's report further revealed that R2 may have slight confusion at times but R2 does not have a dementia diagnosis.

LPA interviewed outside agency (OA) who stated that they are familiar with the incident and they conducted their own investigation. OA stated that they determined that R2 was confused due to R2 being new to the facility. OA stated that they also determined that although R2 did approach R1's room R2 never entered R1's room. OA stated that the investigation was then closed. OA stated that they have been working closely with the facility and the executive director who has been doing a great job of making improvements throughout the facility.

LPA interviewed Executive Director (ED) who stated that in a community setting it is hard to control residents getting lost. ED stated that R2 accidentally entered R1's room due to confusion and immediately walked out when R2 realized it was not R2's room. ED stated that R2 was new so R2's name was not their door yet which added to the confusion.

Based upon the foregoing, the above listed allegation is unsubstantiated. This finding means that the preponderance of the evidence standard has not been met and the allegation is not valid.

An exit interview was conducted with Julia Lopez. A copy of this report along with licensee rights (LIC 9058, 3/22) was provided to Julia Lopez whose signature below verifies receipt of these rights.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Ramon Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 09/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2024

LIC9099 (FAS) - (06/04)

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