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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600133
Report Date: 10/08/2025
Date Signed: 10/08/2025 02:40:25 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 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
08/25/2025 and conducted by Evaluator Jaime Vado
COMPLAINT CONTROL NUMBER: 14-AS-20250825101250
FACILITY NAME:ATRIA PARK OF SAN MATEOFACILITY NUMBER:
415600133
ADMINISTRATOR:PATRICIA HOLGUINFACILITY TYPE:
740
ADDRESS:2883 S NORFOLK STTELEPHONE:
(650) 378-3000
CITY:SAN MATEOSTATE: CAZIP CODE:
94403
CAPACITY:175CENSUS: 81DATE:
10/08/2025
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Manager on duty - Nena ChavezTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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- Staff arranged outside care without consent of resident’s representative
- Staff did not provide resident's representative adequate notice of rate increase
- Staff did not discontinue additional services upon request of resident’s representative
INVESTIGATION FINDINGS:
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On 10/08/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigaiton visit in order to deliver findings regarding the allegations received. LPA met with manager on duty Nena Chavez and explained the purpose of today's visit.

During the investigation, LPA conducted interviews, and reviewed documentation recieved. The facility's admission agreement that the facility can determine if a resident becomes a safety risk to themself or ot others during residency, the facility has the right to obtain a Private Duty Aid (PDA) at the expense of the resident or responsible party to ensure the safety of the resident. Due to the ongoing, and increasing exit seeking behavior of the resident, the facility acquired the PDA and informed the responsible party. The facility did this to ensure that the resident did not leave the facilty unassisted and to ensure the safety of the resident with her other behaviors as well. All associated costs were billed to the responsible party accordingly. According to the facility, the responsible party attempted to stop services but it had to be reactivated by the facility due to the resident continuing to try to leave the facility unassisted and the facility cannot provide 1:1 caregiving or supervision to ensure constant supervision and safety 24/7. Any rate increases in basic services do not require a 30 day notice prior to increase due to the resident's need for the increase in basic care. The fees for the PDA started when the PDA was hired by the facility and billed. The services could not be discontinued due to the resident's behavior risking their own health and safety. This allegation is unfounded.

This agency has investigated the complaint alleging, "- Staff arranged outside care without consent of resident’s representative - Staff did not provide resident's representative adequate notice of rate increase - Staff did not discontinue additional services upon request of resident’s representativeindicate the complaint allegation". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint. Report is reviewed with manager on duty Nena Chavez and a copy is provided.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Jaime Vado
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025
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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