415600980-8-5-2026-14-AS-ACON-DXJPQ5-20260902113031

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600980
Report Date: 08/05/2026
Date Signed: 08/05/2026 02:05:35 PM

Unsubstantiated

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
05/06/2026 and conducted by Evaluator Murial Han

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20260506164928

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: 173	DATE:	08/05/2026
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Administrator, Freddie Fullon		TIME COMPLETED:	02:16 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff retained a resident whose needs could not be met at the facility
Staff charged a resident additional fees for care not provided by facility staff
Staff are not following admission agreement

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On August 5, 2026, Licensing Program Analyst (LPA) Murial Han conducted an unannounced visit to deliver the complaint investigation finding. LPA met with the administrator and explained the purpose of today's visit.

Regarding allegation of staff retained a resident whose needs could not be met at the facility, the reporting party stated that resident #1 (R1) lived at the facility for two years and in 2/2026, R1 had a change of health condition resulting in hospitalization. The reporting party stated that upon R2’s hospital discharge, the facility accepted R2 back to the facility knowing R2 required two-person assistance, home health services and other care that should have been provided by skilled medical professionals in a skill nursing facility.

As part of the investigation, LPA interviewed the administrator and reviewed documents.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2026

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-20260506164928

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ATRIA AT FOSTER SQUARE	FACILITY NUMBER: 415600980
	VISIT DATE: 08/05/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The administrator denied the allegation and stated that before R1 returned to the facility, the facility conducted a preplacement appraisal that revealed R1 required two-person assistance and increased in care needs. The administrator stated that the outcome of the preplacement appraisal was discussed with the responsible party who wanted R1 return to the facility. Therefore, R1's plan of care was discussed with the responsible party and R1 returned with home health and a private duty caregiver.

Based on documents provided, LPA observed a written communication between R1’s responsible party and the facility directors explaining the care that R1 would required upon returning to the facility after the hospitalization.

Based on R1’s physician’s order/LIC602 dated 2/11/2026, the facility readmitted R1 with an ambulatory status that was within the facility’s fire clearance.

After the investigation, this allegation is deemed to be unsubstantiated as prior to R1’s return, the facility conducted a preplacement appraisal and communicated in writing with R1’s responsible party of R1’s care needs. In addition, the facility readmitted R1 whose ambulatory status was within the facility’s fire clearance.

Regarding the allegation of – staff charged a resident additional fee for care not provided by facility staff, the reporting party stated that because the facility accepted R1 back into the facility inappropriately, R1 spent 13 days lying in a bed instead of getting rehabilitative therapy and occupational therapy.

The administrator denied the allegation and stated that R1 received therapy services from a home health agency with a schedule that was developed by the therapists. In addition, the administrator stated that R1’s care needs were developed based on R1’s needs and all the tasks were completed.

Based on the documentation of R1’s Resident Monthly Completed Tasks by Resident, it revealed that the facility staff members completed activities/tasks such as Activities of Daily Living, resident hourly overnight checks, incontinent care, and etc.

After the investigation, this allegation is deemed to be unsubstantiated.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 14-AS-20260506164928

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066

FACILITY NAME: ATRIA AT FOSTER SQUARE	FACILITY NUMBER: 415600980
	VISIT DATE: 08/05/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Regarding the allegation of – staff are not following admission agreement, the reporting party stated that the facility admission agreement stipulates that a resident would not be accepted back into care if a resident required 24/7 care or two person assist.

As part of the investigation, LPA interviewed the administrator, reviewed R1’s physician’s order upon hospital discharge, and reviewed R1’s admission agreement.

According to the administrator, the facility accepted and retained R1 back into the facility knowing that R1 required two person assistance because R1's responsible party requested for R1 to return, R1 resided at the facility for two years and the facility was R1’s home. In addition, the administrator stated that R1 was deconditioned due to change of health condition so they were hoping the increase in care was temporary due to hospitalization.

Based on the physician’s order, R1 did not required 24/7 nursing care. Therefore, R1 retuned to the facility.

Base on record review and interviews during the course of investigation, this allegation is deemed to be unsubstantiated.

Although the above investigations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

This report is reviewed and discussed with the administrator and a copy is provided.

SUPERVISORS NAME: April Cowan
LICENSING EVALUATOR NAME: Murial Han
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3