374600890-5-22-2025-08-AS-APAO-DH5R7V-20250529124658

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 05/07/2025
Date Signed: 05/22/2025 10:56:44 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
10/11/2024 and conducted by Evaluator Sabel Martinez

COMPLAINT CONTROL NUMBER: 08-AS-20241011124100

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: 94	DATE:	05/07/2025
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Maintenance Director Omar Zamudio		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff are not providing a comfortable environment for resident.
Staff did not ensure resident's room was free from odor.

INVESTIGATION FINDINGS:

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This is an amended report to a report originally signed on 5/7/2025.
Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced follow up complaint investigation visit and delivered complaint findings. The LPA introduced himself and disclosed the purpose of the visit to Maintenance Director Omar Zamudio.

Throughout the investigation, the Department secured records and conducted interviews with external and internal sources, including staff and residents.
It was alleged staff did not provide a comfortable environment for a resident. On October 11th, 2024, it was reported to the Department a resident screaming at the facility had made a resident feel uncomfortable. Interviews with staff and residents revealed Resident # 1 (R1) would scream, yell at R1’s television, and kept R1’s television volume loud. Interviews and review of records revealed staff encouraged R1 to lower the television volume, or keep R1’s bedroom door closed, to minimize the noise. (See LIC 9099-C for continuation of report.)

Unsubstantiated

Estimated Days of Completion: 0

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

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-20241011124100

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: 05/07/2025

NARRATIVE

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R1 consistently refused, made verbal threats and attempted to physically assault staff. Residents in the vicinity of R1’s bedroom did not report being afraid but described R1’s behaviors as a nuisance. Interviews with residents confirmed staff would attempt to redirect R1, but R1 would come verbally and physically aggressive.

An interview with the facility’s Executive Director, and a review of records, revealed the facility had advised R1 to follow house rules stipulated in R1’s admission agreement. R1 did not comply, and the facility provided R1 a thirty (30) day eviction notice. The facility pursued an unlawful detainer action through the court, and R1 was subsequently escorted off the facility by the Sheriff’s office.

Although R1’s behaviors had become a nuisance to residents, the facility admonished R1 to comply with house rules, and the facility followed eviction procedures. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

It was also alleged staff did not ensure a resident's bedroom was free from odor. On October 11th, 2024, it was reported to the Department Resident # 1’s (R1) bedroom smelled of urine. Interviews with both staff and residents confirmed R1 often refused to have staff clean R1’s bedroom. Although each bedroom was scheduled to be cleaned once per week, R1’s bedroom was consistently being cleaned more than one time per week. R1 made verbal and physical threats to staff who attempted to assist R1. Interviews with staff revealed R1’s bedroom carpet was frequently washed to prevent odors, and R1 was encouraged to maintain the bedroom clean, but R1 disregarded staff. The Department attempted to interview R1, but R1 was no longer residing at the facility. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted with Zamudio, to whom a copy of this report, LIC 811 Confidential names list, and Licensee/Appeals Rights (LIC 9058), were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 05/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025

LIC9099 (FAS) - (06/04)

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