415600995-9-19-2025-14-AS-BCHN-DMW84W-20251028221149

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600995
Report Date: 09/19/2025
Date Signed: 09/19/2025 02:25:53 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
06/16/2025 and conducted by Evaluator John Calandra

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20250616151620

FACILITY NAME:	ATHERTON GARDENS		FACILITY NUMBER:	415600995
ADMINISTRATOR:	HOVORKA, KIMBERLY		FACILITY TYPE:	740
ADDRESS:	471 SANTA CLARA AVE		TELEPHONE:	(650) 993-9313
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94061
CAPACITY:	6	CENSUS:	DATE:	09/19/2025
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:			TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff did not provide resident with proper notification prior to rate increase
Staff are retaliating against resident for filing a complaint

INVESTIGATION FINDINGS:

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On 9/19/2025, Licensing Program Analyst(LPA) John Calandra conducted a phone call to deliver conclusionary findings for this complaint investigation. LPA explained the purpose of the visit via voicemail as no facility representative picked up the phone.

Complaint alleged that staff did not provide proper notification of a rate increase. Per the Health and Safety Code, if a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 90 days’ prior written notice to the residents or the residents’ representatives except for an increase in the rate due to a change in the level of care of the resident. Based on document review and interviews, R1 was provided a 3 day and 30-day notice of a rate change due to a change in the level of care needed for the resident based on a reassessment of their needs and services.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025

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-20250616151620

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: ATHERTON GARDENS	FACILITY NUMBER: 415600995
	VISIT DATE: 09/19/2025

NARRATIVE

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Complaint also alleged that staff are retaliating against a resident for filing a complaint. Based on document review and interviews, the facility increased R1’s level of care charges due to a change in their needs and services as specified in a recent reassessment of the resident.

Based on the fact that R1 had been re-evaluated and that their rate was increased due to a change in their level of care, the above allegations are unsubstantiated. Although the allegations 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 above allegations are unsubstantiated at this time.

No deficiencies cited.

An exit interview was conducted. This report will be sent to the Licensee with a request to sign and send a copy back to the Department by 9/26/2025.

SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE:	DATE: 09/19/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025

LIC9099 (FAS) - (06/04)

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