415600133-9-6-2023-14-AS-KHOS-CVKHPP-20230911062240

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600133
Report Date: 09/06/2023
Date Signed: 09/06/2023 01:12:13 PM

Unsubstantiated

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
08/24/2023 and conducted by Evaluator Audrey Jeung

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230824164415

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: 81	DATE:	09/06/2023
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Jennifer Duenas and Shanel Thitphaneth		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff does not ensure resident is transported to scheduled appointments in a timely manner.

INVESTIGATION FINDINGS:

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Based on LPA Jeung's review of facility's client records and transporation schedules, and interviews with staff and clients, this allegation is determined to be unsubstantiated.

According to administrator, facility employs a driver who transports residents to medical appointments on Mondays, Wednesdays and Fridays, and shopping and scenic drives on Tuesdays and Thursdays. Based on review of facility's transporation schedules for the past 3 months, client #1 utilizes the transportation service 3 times/week to scheduled medical appointments. Pickup time is 30 minutes prior to scheduled appointment time to allow for any delays, and destination is 5 minutes away. According to facility driver, client has never missed a scheduled appointment due to facility's failure to provide timely transporation. Client has been 5 - 7 minutes late on occasion, due to client's tight scheduling of care needs and availability of staff.

Although the allegation may have occurred or is valid, there is not enough evidence to prove the alleged violation did or did not occur.

Unsubstantiated

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: 09/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/06/2023

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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