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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600787
Report Date: 04/16/2024
Date Signed: 04/16/2024 11:04:46 AM


Document Has Been Signed on 04/16/2024 11:04 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066



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: 42DATE:
04/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Resident Services Director - Nora SaavedraTIME COMPLETED:
11:15 AM
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On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced required 1 year annual inspection. LPA met with resident services director Nora Saavedra who also holds a valid administrator certificate. The administrator Garry Sneper is not present on this day. LPA met with Nora and explained the purpose of today's visit.

LPA was allowed entry into the facility that is licensed to serve 42 residents all of whom may be non-ambulatory. Annual Fees are current. The physical plant was toured inside and outside to ensure the safety of the residents. During today's visit LPA observed two group activities taking place in separate community rooms in the facility. LPA observed the facility kitchen which is locked from resident access. Knives are stored within the kitchen behind closed door. Perishable and non-perishable food items are observed as in place. LPA observed the the medication room is behind a counter in the front of the facility and has a lockable door. Resident medications are in place and current. The first aid kit is maintained in the medication room and is complete with required items. LPA observed a pull alarm fire system, fire extinguishers through out the facility inspected 04/08/24, smoke detector/carbon monoxide detectors, fire sprinklers through out, and central heating in the facility as in place. PPE and additional food supplies are observed on the second floor of the facility. Laundry room is also observed on the second floor as fully operational. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Resident rooms were observed at random and all contained the required furniture as outlined in regulations. Water temperature is tested at 108F in resident room bathroom at the rear of the facility.

The facility does not handle resident money. Liability insurance is observed as in place and current. Current administrator certificate for Garry Sneper is current expiring on 07/15/2024. Nora's expiration date for certificate expired as 03/17/2024 and is currently pending renewal as all items have been sent in for renewal.

Per the California Code of Regulations, Title 22, Division 6, Chapter 6, no deficiencies observed or cited. Report reviewed with Nora Saavedra.
SUPERVISOR'S NAME: April CowanTELEPHONE: (650) 266-8865
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:
DATE: 04/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/16/2024
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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