415600980-8-4-2023-14-AS-CSMH-CUJMYT-20230809100204

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600980
Report Date: 08/04/2023
Date Signed: 08/04/2023 02:30:57 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
09/02/2022 and conducted by Evaluator Komal Charitra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20220902155514

FACILITY NAME:	ATRIA AT FOSTER SQUARE		FACILITY NUMBER:	415600980
ADMINISTRATOR:	FREDDIE FULLON		FACILITY TYPE:	740
ADDRESS:	707 THAYER LN		TELEPHONE:	(650) 532-2460
CITY:	FOSTER CITY	STATE: CA	ZIP CODE:	94404
CAPACITY:	216	CENSUS: 145	DATE:	08/04/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Administrator, Freddie Fullon		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Resident had multiple falls
Staff did not observe change in resident's condition
Staff did not seek medical attention timely for a resident
Staff left resident in bed for long periods of time

INVESTIGATION FINDINGS:

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On August 4, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver findings for the above allegations. LPA met with Administrator, Freddie Fullon and explained the purpose of the visit.

Regarding the allegation that resident had multiple falls, staff did not observe change in resident’s condition and staff did not seek medical attention timely for a resident, according to the reporting party, the facility failed to seek medical attention when Resident 1 (R1) developed a serve UTI and due to the lack of care, R1 had multiple falls.

During the investigation, LPA interviewed the administrator and reviewed R1’s file. The administrator denied these allegations and indicated that R1 did have five falls within two weeks (6/13/22, 6/16/22, 6/23/22, 6/23/22, and 6/24/22), however every time R1 was observed on the floor or had an un-witnessed fall, R1’s physician and responsible party would be notified. Based on file reviewed, the facility staff documented R1’s falls and was in communication with R1’s physician and responsible party after each fall. In addition, based on file reviewed, LPA observed on 6/16/2022, after R1 had a second fall within three days, the facility put R1 on status checks every 2 hours. Furthermore, on 6/26/2022, when the facility contacted R1’s physician and responsible party with concerns regarding R1’s frequent falls, the physician adjusted R1’s medication and R1’s responsible party hired a private caregiver for fall management. Nevertheless, although R1 did have multiple falls, the facility did seek timely medical attention and observed changes in R1’s condition. (CONT. TO 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal Charitra	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

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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Control Number 14-AS-20220902155514

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ATRIA AT FOSTER SQUARE	FACILITY NUMBER: 415600980
	VISIT DATE: 08/04/2023

NARRATIVE

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Regarding the allegation that staff left resident in bed for long periods of time, according to the reporting party, R1’s room smelled like urine.

During the investigation, LPA interviewed the administrator and reviewed R1's file. The administrator denied this allegation and indicated that R1 was independent and did not require toileting assistance, however R1 was verbal and if he/she needed assistance, the facility staff would assist with toileting. Based on R1's needs and service plan, R1 was independent in the mechanics of toileting. In addition, based on R1's physicians report, R1 was able to care for his/her own toileting needs.

Based on the information collected and interviews conducted ,although the above allegation may have happened or are valid, there is no preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are UNSUBSTANTIATED.

Report is reviewed with the administrator and a copy is provided.

SUPERVISOR'S NAME: Cara Smith	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Komal Charitra	TELEPHONE: (650) 266-8800
LICENSING EVALUATOR SIGNATURE:	DATE: 08/04/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2023

LIC9099 (FAS) - (06/04)

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