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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600787
Report Date: 03/13/2025
Date Signed: 03/13/2025 03:26:02 PM

Document Has Been Signed on 03/13/2025 03:26 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
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:PALM VILLASFACILITY NUMBER:
415600787
ADMINISTRATOR/
DIRECTOR:
SNEPER, GARRYFACILITY TYPE:
740
ADDRESS:1931 WOODSIDE ROADTELEPHONE:
(650) 369-3197
CITY:REDWOOD CITYSTATE: CAZIP CODE:
94061
CAPACITY: 49CENSUS: 38DATE:
03/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:40 AM
MET WITH:Nora Saavedra, Administrator TIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 3/13/2025, Licensing Program Analyst(LPA) John Calandra arrived at the facility at 9:40 AM to conduct the Annual 1-year required inspection. LPA Calandra was greeted by Nora Saavedra, Administrator and explained the purpose of the visit.

LPA toured the physical plant. This is a 1-story building with 30 bedrooms and 30 bathrooms, a living room, dining room, kitchen, and outdoor space/backyard. All bedrooms had the required furniture and sufficient lighting. No accessible bodies of water or hazards were observed in hallways or the backyard. The facility's fire alarms and Carbon Monoxide detector were observed to be in working order. The facility's first aid kit was observed to have all required items. The facility had the required 7 days of non perishables and 2 days of perishables on site. No food was expired. The facility was maintained at a comfortable temperature of 70 degrees Fahrenheit. The facility's hot water was measured between the required 105-120 degrees Fahrenheit. The facility's fire extinguishers were last serviced on 4/8/2024.

All sharp objects, poisons, and detergents were observed to be locked and in-accessible to persons in care.

LPAs reviewed 5 resident records and 6 staff files. All were observed to be complete. This facility does not handle cash for residents.

A review of Centrally stored medications indicated that medications for residents were properly labeled with instructions on dosage and times of day and matched the Centrally Stored Medication records kept at the facility.

LPA Calandra received the following documents while at the facility:
-Administrator Certificates
-LIC 500

LPA Calandra requested the following documents be sent to the Department by 3/21/2025:
-Transportation Procedures
-LIC 308: Designation of Facility Responsibility
-LIC 400
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME: PALM VILLAS
FACILITY NUMBER: 415600787
VISIT DATE: 03/13/2025
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No deficiencies were cited during today's visit.

An exit interview was conducted. This report was reviewed with Nora Saavedra, Administrator and a copy of the report left at the facility.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: John Calandra
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
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