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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600890
Report Date: 12/05/2024
Date Signed: 12/05/2024 09:04:50 PM

Document Has Been Signed on 12/05/2024 09:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ATRIA COLLWOODFACILITY NUMBER:
374600890
ADMINISTRATOR/
DIRECTOR:		JULIA LOPEZFACILITY TYPE:
740
ADDRESS:5308 MONROE AVETELEPHONE:
(619) 286-3583
CITY:SAN DIEGOSTATE: CAZIP CODE:
92115
CAPACITY: 185CENSUS: 96DATE:
12/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
04:00 PM
MET WITH:Executive Director Julia LopezTIME VISIT/
INSPECTION COMPLETED:
04:40 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced case management visit at the facility. LPA gained access to the facility, identified herself, and met with Executive Director (ED) Julia Lopez to whom was explained the purpose of the visit.

During today's visit LPA conducted a staff interview and secured resident records.

Today's visit was in response to an Incident Report received on November 22, 2024, by Community Care Licensing (CCL) regarding Resident 1 (R1). No deficiencies were cited during today's visit.(See LIC 811 for confidential name).

An exit interview was conducted with ED Lopez and a copy of this report and Licensee/Appeal Rights (LIC9058 01/16) will be provided at the conclusion of the visit. Signature below confirms receipt of the reports.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2024
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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