415600980-10-6-2023-14-AS-KHOS-CWNJD5-20231016065654

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600980
Report Date: 10/06/2023
Date Signed: 10/06/2023 11:05:26 AM

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
04/25/2023 and conducted by Evaluator Komal Charitra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230425113110

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: 144	DATE:	10/06/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator, Freddie Fullon		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Staff failed to provide a comfortable temperature for residents
Facility is in disrepair
Staff failed to provide a safe and comfortable environment for residents

INVESTIGATION FINDINGS:

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On October 6, 2023, Licensing Program Analyst (LPA) Komal Charitra conducted an unannounced complaint visit to deliver findings for the above. LPA met with Administrator, Freddie Fullon and explained the purpose of the visit.

Regarding the allegation that staff failed to provide a comfortable temperature for residents, facility is in disrepair, and staff failed to provide a safe and comfortable environment for residents, according to the reporting party, at the end of December of 2022, there was no heat in some of the resident apartment rooms, in addition to the private dining room. According to the reporting party, facility personnel and third-party HVAC vendor were notified, however they were unable to turn on the heat. Furthermore, the reporting party indicated that space heaters were provided for heating, however they were fire and safety hazards due to potential burns.

During the investigation, LPA interviewed administrator, residents, reviewed documentation provided, and toured the facility. The administrator acknoweledged that the heating units were in disrepair, however HVAC was immediately contacted. The administrator indicated that there were not many complaints regarding the heating units being in disrepair from residents, however for the residents who needed more heat, the facility offered space heaters to offset the temperature temporarily or have residents move to another room temporarily while contractors tried to repair the heating system. In addition, the administrator indicated that the facility tried their best to ensure residents were safe and comfortable when the heating units were not working as the Maintenance Director was checking in on residents 2-3x a day. Furthermore, the administrator stated that there was a delay with the repairs due to HVAC ordering and waiting for required parts, and due to the winter storms.

Continue 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: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

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 3

Control Number 14-AS-20230425113110

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: 10/06/2023

NARRATIVE

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Based on documentation provided, facility called third-party HVAC vendor who arrived to the facility on 12/19/22, to diagnose the heating units that were not in working condition. According to documents reviewed, HVAC vendor came to the facility between 12/19/22 through 5/17/23 to troubleshoot and repair the heating units at the facility, in addition to additional damages and issues that were observed by the contractors. According to the administrator, the heating units were on and off due to other damages that were discovered by HVAC vendor, however administrator and HVAC were in contact daily by phone or in person.

According to 3/3 residents who did not have a working heating unit, they indicated that they were comfortable, staff checked on them, and they were provided with space heaters in case they needed it. On 10/6/2023, LPA toured four rooms that did not have working heating units during the winter storms. Heating and cooling unit was observed to be in good working condition.

Therefore, based on the documents reviewed, information reviewed, and interviews conducted, the allegations above are UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove that the alleged violation occurred.

Report is reviewed with 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: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

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
04/25/2023 and conducted by Evaluator Komal Charitra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20230425113110

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: 144	DATE:	10/06/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator, Freddie Fullon		TIME COMPLETED:	11:20 AM

ALLEGATION(S):

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Staff failed to issue a refund

INVESTIGATION FINDINGS:

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Unfounded

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: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 3