415600133-12-1-2022-14-AS-CSMH-CM9P48-20221219095843

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600133
Report Date: 11/30/2022
Date Signed: 12/01/2022 04:02:26 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/23/2022 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20220923162046

FACILITY NAME:	ATRIA PARK OF SAN MATEO		FACILITY NUMBER:	415600133
ADMINISTRATOR:	JENNIFER DUENAS		FACILITY TYPE:	740
ADDRESS:	2883 S NORFOLK ST		TELEPHONE:	(650) 378-3000
CITY:	SAN MATEO	STATE: CA	ZIP CODE:	94403
CAPACITY:	175	CENSUS: 82	DATE:	11/30/2022
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Jennifer Duenas		TIME COMPLETED:	06:30 PM

ALLEGATION(S):

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- Staff is having an inappropriate relationship with a resident in care

- Staff used resident funds to acquire property

INVESTIGATION FINDINGS:

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LPA Jeung met with administrator, interviewed staff, and reviewed staff file.

LPA initiated this investigation on 10/3/22 and conducted a follow up investigation visit on 10/24/22.
Investigation included interviews with alleged witnesses and above mentioned staff and review of staff file.

The above allegations are determined to be unfounded, based on this investigation, This means that the allegation could not have happened and/or is without a reasonable basis.

*******This report signed and printed on 12/1/22*********

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Audrey Jeung	TELEPHONE: (650) 266-8891
LICENSING EVALUATOR SIGNATURE:	DATE: 11/30/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2022

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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