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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 011405349
Report Date: 07/28/2023
Date Signed: 07/28/2023 02:32:41 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/05/2023 and conducted by Evaluator Gregory Clark
COMPLAINT CONTROL NUMBER: 15-AS-20230505142411
FACILITY NAME:PALM TREE RESIDENTIAL CARE HOME #2FACILITY NUMBER:
011405349
ADMINISTRATOR:BERTHA REEDFACILITY TYPE:
735
ADDRESS:2212 - EAST 19TH STREETTELEPHONE:
(510) 532-7785
CITY:OAKLANDSTATE: CAZIP CODE:
94606
CAPACITY:11CENSUS: 5DATE:
07/28/2023
UNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:Nathaniel Reed, Administrator TIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff mistreated and abused client's in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 7/28/23 at 2:20 p.m., Licensing Program Analyst (LPA) Greg Clark arrived unannounced to deliver findings in regards to the allegation above. LPA met with Nathaniel Reed, Administrator and explained the purpose of the visit.
Based on an investigation completed on 6/22/2023 (compliant #15-AS-20230209155140) by the Department, it was determined that S1 was physically abusive to residents in care.

The preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. Citation was issued on 6/22/2023 from California Code of Regulations (Title 22, Division 6, Chapter 8), was cited on a LIC 9099D. Immediate exclusion was provided to the facility on 6/22/2023 for S1.

Exit interview conducted and a copy of this report provided.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Gregory Clark
LICENSING EVALUATOR SIGNATURE:

DATE: 07/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/28/2023
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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