415600787-5-17-2021-14-AS-KHOS-C3CHPD-20210525062206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 415600787
Report Date: 05/17/2021
Date Signed: 05/17/2021 03:22:11 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
07/09/2020 and conducted by Evaluator Jaime Vado

PUBLIC

COMPLAINT CONTROL NUMBER: 14-AS-20200709135521

FACILITY NAME:	PALM VILLAS		FACILITY NUMBER:	415600787
ADMINISTRATOR:	SNEPER, GARRY		FACILITY TYPE:	740
ADDRESS:	1931 WOODSIDE ROAD		TELEPHONE:	(650) 369-3197
CITY:	REDWOOD CITY	STATE: CA	ZIP CODE:	94061
CAPACITY:	49	CENSUS: 40	DATE:	05/17/2021
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Nora Saavedra		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Illegal Eviction

INVESTIGATION FINDINGS:

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On May 17, 2021 at 1345 LPA Jaime Vado conducted an unannounced complaint
inspection to deliver findings regarding the allegation received. LPA met with resident services director Nora Saavedra and explained purpose for today's inspection.

During the course of the investigation LPA conducted interviews and reviewed documents recieved from the facility. It was discovered that the resident was not evicted from the facility. At the time the resident was recieving medical assistance he was exhibiting symptoms the facility believed that required medical attention. The resident was then directed to another medical facility for recovery. Upon completion of recovery the resident returned to the facility. No eviction notice was notnissued to the resident or family at any time. The resident's bed and belongings remained at the facility. Due to the discoveries made the allegation is deemed unfounded.

Based on the information obtained, the above allegation is UNFOUNDED, meaning that the allegation is false, could not have happened and/or is without a reasonable basis.

Report reviewed with Nora.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Julio Montes	TELEPHONE: (650) 272-7906
LICENSING EVALUATOR NAME: Jaime Vado	TELEPHONE: (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)

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