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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 02:41:37 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
08/01/2025 and conducted by Evaluator Jaime Vado
COMPLAINT CONTROL NUMBER: 14-AS-20250801131304
FACILITY NAME:ATRIA PARK OF SAN MATEOFACILITY NUMBER:
415600133
ADMINISTRATOR:BROOKS, THOMAS KIRKFACILITY 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):
1
2
3
4
5
6
7
8
9
- Unlawful eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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. In regards to the unlawful eviction, based on the eviction letter, and incidents documented regarding the behaviors of the reisdent, the facility abided by the regulations in regards to eviction. Additionally, based on the admission agreement reviewed, the facility can make the decision to evict a resident based on behaviors, or violation of facility rules, or unable to meet the needs of a resident, the facility is able to evict a resident. The resident has documented reports of exit seeking behaviors, yelling, and striking staff. The facility did not find it safe for the resident to be placed in memory care as this behavior may have continued or increased due the residnet residing in a more strict living situation and setting with other vulnerable residents. This allegation is unfounded.

This agency has investigated the complaint alleging, "Unlawful eviction". 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)
Page: 1 of 2
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
08/01/2025 and conducted by Evaluator Jaime Vado
COMPLAINT CONTROL NUMBER: 14-AS-20250801131304

FACILITY NAME:ATRIA PARK OF SAN MATEOFACILITY NUMBER:
415600133
ADMINISTRATOR:BROOKS, THOMAS KIRKFACILITY 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):
1
2
3
4
5
6
7
8
9
- Staff did not conduct a proper reassessment of resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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. In regards to staff not conducting a proper reassessment of resident, LPA reviewed both assessments conducted. The latest was conducted on June 24, 2025 where it found that the behaviors of the resident had increased since the initial intake assessment. Behaviors were identified at intake, but according to the facility, over time behaviors had increased to the point of the resident striking staff as her exit seeking behvaior increased. Although some of the behviors were present at initial assessment, some behaviors did increase to a level where the facility found they aren't able to meet the needs of the resident any longer. This allegation is unsubstantiated.

Based on these observations, the above allegations are UNSUBSTANTIATED.
Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are unsubstantiated at this time.
Unsubstantiated
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)
Page: 2 of 2