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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600890
Report Date: 06/10/2025
Date Signed: 06/11/2025 06:20:28 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
06/28/2023 and conducted by Evaluator Debbie Correia
COMPLAINT CONTROL NUMBER: 08-AS-20230628101740
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: 95DATE:
06/10/2025
UNANNOUNCEDTIME BEGAN:
06:15 PM
MET WITH:Med-tech Amy BarajasTIME COMPLETED:
07:30 PM
ALLEGATION(S):
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Staff are charging resident for services not rendered.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced visit to commence and conclude a complaint investigation regarding the above-mentioned allegation. LPA identified herself to Front Receptionist Griselda Pacheco and met with the Director of Maintenance (DOM) Omar Zamudio and Executive Director (ED) Julia Lopez and discussed the purpose of the visit and the basic elements of the allegation.

The Department's investigation included staff and resident interviews, and facility and resident records reviews.

On June 28, 2023, the Department received a complaint that alleged staff were charging Resident1 [R1] for services not rendered. More specifically, R1 alleged being billed through June of 2023, for assistance with showering that were never received. A resident records review revealed R1 was admitted to the facility on February 23, 2023, and at the time of admission R1 required assistance with showering.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 08-AS-20230628101740
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: 06/10/2025
NARRATIVE
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Further review of R1’s records revealed as of May of 2023, R1 had refused staff assistance with showering,. On July 05, 2023, revealed R1 requested assistance with showering to be removed from their care plan and subsequently facility records showed on that same day, July 5, 2023, staff requested authorization (marked urgent) from R1’s Primary Care Physician (PCP) to allow R1 to shower on their own which was approved and signed on July 10, 2023. Interviews conducted with other residents in care revealed no issues with staff assistance with care on their plan of care,

Based on facility, resident, and outside source records reviews, and staff and resident interviews the Department determined the allegation to be unsubstantiated. This finding means there was not a preponderance of evidence to prove that the alleged violation occurred.

An exit interview was conducted with Med-tech Barajas and a copy of this report and Licensee/Appeal Rights (LIC 9058) were provided to staff at the conclusion of the visit.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 06/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2