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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202301
Report Date: 08/04/2022
Date Signed: 08/04/2022 03:00:04 PM


Document Has Been Signed on 08/04/2022 03:00 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:PALM VILLAS, CAMPBELLFACILITY NUMBER:
435202301
ADMINISTRATOR:SNEPER, GARRYFACILITY TYPE:
740
ADDRESS:3333 SOUTH BASCOM AVENUETELEPHONE:
(408) 559-8301
CITY:CAMPBELLSTATE: CAZIP CODE:
95008
CAPACITY:48CENSUS: 41DATE:
08/04/2022
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Nora NaaveraTIME COMPLETED:
03:05 PM
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Licensing Program Analyst Ryker Heberle (LPA) conducted an unannounced annual inspection on 08/04/2022 at 1:05pm. LPA met with Palm Villas Administrator Nora Saavera (S1). Administrator Gary Sneper (Admin) was currently on vacation and was unable to attend the inspection. LPA was informed that Admin would be on vacation during inspection that took place on 07/12/2022. During 07/12/2022 inspection Admin stated that S1 would be able to sign reports in his stead.

LPA toured the facility with S1. During tour of the facility, LPA observed the facility to be operating within regulation, including compliance with personal rights and allowable health conditions. LPA observed the facility's probationary license posted both on the bulletin board outside of the Administrators office, as well as framed in the receptionist's office and in the waiting room outside of administrative offices. LPA confirmed maintenance of home health agreements. No additional home health agreements have been created since visit on 07/12/2022

No additional administrator training documentation has been generated since case management inspection on 07/12/2022. Admin has already completed all necessary course work.

No deficiencies cited during today's visit. This report was reviewed with Palm Villas Administrator Nora Saavera and a copy of this report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Ryker HeberleTELEPHONE: 714-328-5152
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022
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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