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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 415600787
Report Date: 10/31/2023
Date Signed: 10/31/2023 12:58:12 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SF COASTAL AC/SC, 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
02/27/2023 and conducted by Evaluator Jaime Vado
PUBLIC
COMPLAINT CONTROL NUMBER: 14-AS-20230227163514
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: 38DATE:
10/31/2023
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Nora SaavedraTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
- Resident sustained multiple falls while in care
- Insufficient staffing during the evening hours for the residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On this day, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced complaint investigation visit in order to deliver findings regarding the allegations received. LPA met with resident services director Nora Saavedra and explained the purpose of today's visit.

During the investigation LPA conducted interviews and reviewed documents regarding R1. Incident reports are received documenting the falls. The facility does not have one on one care unless the responsible party agrees to pay for that additional care from an outside agency. This was not initiated by the responsible parties. The facility attempted to work with the family in order to increase supervision but the falls kept occurring naturally. Night staffing in place according to staffing schedule received. These allegations are unsubstantiated.

Based on these observations, the above allegations 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. A copy is provided on this day.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cara SmithTELEPHONE: (650) 266-8800
LICENSING EVALUATOR NAME: Jaime VadoTELEPHONE: (559) 476-9353
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2023
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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