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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600980
Report Date: 09/27/2022
Date Signed: 09/27/2022 01:14:17 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
02/17/2022 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20220217112631
FACILITY NAME:ATRIA AT FOSTER SQUAREFACILITY NUMBER:
415600980
ADMINISTRATOR:FREDDIE FULLONFACILITY TYPE:
740
ADDRESS:707 THAYER LNTELEPHONE:
(650) 532-2460
CITY:FOSTER CITYSTATE: CAZIP CODE:
94404
CAPACITY:216CENSUS: DATE:
09/27/2022
UNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Fredie FullonTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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- Facility has inadequate staffing resulting in lack of care for residents
- Staff are mismanaging resident's medications
INVESTIGATION FINDINGS:
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On this day Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit to deliver findings regarding the allegations received. LPA met with Freddie Fullon and explained purpose of today's visit.

During the course of the investigaiton LPA recevied documents, conducted interviews with staff, and made observations. LPA observed staffing as in place in the areas observed. LPA toured with facility staff and could not determine a lack of staffing or care. In regards to the mismangement of medications, LPA reveiwed medication logs, conducted interviews, and reviewed incident reports. There were no incident reports made to the Department. According to staff there were no reports of the mismanagement of medications as well. LPA could not prove or disprove the allegations received. The allegations are unsubstantied.

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:
SUPERVISOR'S NAME: Jackie JinTELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2022
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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