<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600787
Report Date: 05/17/2021
Date Signed: 05/17/2021 03:27:33 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/26/2020 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20200526135223
FACILITY NAME:PALM VILLASFACILITY NUMBER:
415600787
ADMINISTRATOR:SNEPER, GARRYFACILITY TYPE:
740
ADDRESS:1931 WOODSIDE ROADTELEPHONE:
(650) 369-3197
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY:49CENSUS: 40DATE:
05/17/2021
UNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Garry SneperTIME COMPLETED:
03:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unexplained injuries
Staff failed to provide medical attention in a timely manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On May 17, 2021 at 1345 LPA Jaime Vado conducted an unannounced complaint
tele-inspection to deliver findings regarding the allegations received. LPA met with resident services director Nora Saavedra and explained purpose of today's inspection.

During the course of the investigation LPA conducted interviews and reviewed pertinent records for R1 and R2. It was found that both residents had similar conditions that would cause swelling in their distal extremities. Both residents were seen at the same time with the same condition on the same hands. Both residents were observed by staff and at the time of observation no medical attention was needed. Incident reports were created for these incidents and sent to the Deprtment. R1 was seen by the hospital due to injuring his finger that caused some swelling. R1 was discharged with a care plan that facility was maintaining. Medical attention was called for R2 and returned the same day with no injuries found. Due to the facility knowing the conditions of the residents already, and them not needing medical attening for their conditions based on their health history. Any unexplained injuries are reported by facility. The allegations are unsubstantiated.

Based on these observations, the above allegation are UNSUBSTANTIATED.
Although the allegations may have happened or is 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.

Report is reviewed with Nora.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Julio MontesTELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2021
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