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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600995
Report Date: 09/19/2025
Date Signed: 09/19/2025 02:47:34 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
05/27/2025 and conducted by Evaluator John Calandra
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20250527153117
FACILITY NAME:ATHERTON GARDENSFACILITY NUMBER:
415600995
ADMINISTRATOR:HOVORKA, KIMBERLYFACILITY TYPE:
740
ADDRESS:471 SANTA CLARA AVETELEPHONE:
(650) 993-9313
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:6CENSUS: DATE:
09/19/2025
UNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:TIME COMPLETED:
02:46 PM
ALLEGATION(S):
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Staff handled resident in a rough manner resulting in resident sustaining an injury
Staff spoke inappropriately to resident in care
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 handled resident, R1 in a rough manner resulting in resident sustaining an injury. Based on interviews, R1 requires assistance with transfers and S1 assists them. According to S1, they hold R1’s hand during transfers. R1 has been diagnosed with a disease that causes them to shake and wears a large watch loosely on their arm which led to the injury.

Complaint also alleged that staff spoke inappropriately to resident, R1. Based on interviews, R1 has asked staff if they have called them inappropriate words as R1 has hearing difficulty. Based on interviews and observations, staff speak to all residents in a respectful manner.

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)
Page: 1 of 2
Control Number 14-AS-20250527153117
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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Based on information gathered at this time, the allegations are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. Therefore the above allegation is unsubstantiated at this time.

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)
Page: 2 of 2