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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 011400493
Report Date: 02/13/2024
Date Signed: 02/13/2024 02:52:16 PM

Document Has Been Signed on 02/13/2024 02:52 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PALM TREE HOMEFACILITY NUMBER:
011400493
ADMINISTRATOR:BIRTHA S. REEDFACILITY TYPE:
735
ADDRESS:2219 EAST 19TH STREETTELEPHONE:
(510) 599-4566
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY: 9CENSUS: 0DATE:
02/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Nathaniel Reed, AdministratorTIME COMPLETED:
03:00 PM
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On 2/13/24 at 2:30 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to conduct 1-Year Annual Required inspection. LPA met with Administrator, Nathaniel Reed and explained the purpose of the visit. The facility’s fire clearance was approved for 9.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water. LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the kitchen sink was measured at 108.5-degree Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition.

Smoke detectors and carbon monoxide were in operating condition during visit.

There are currently no residents at this facility

No deficiencies were cited during this inspection. Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE: DATE: 02/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/13/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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