435202301-2-8-2024-26-AS-KHOS-D36KCM-20240308064722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 435202301
Report Date: 01/08/2024
Date Signed: 02/08/2024 03:57:57 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/12/2022 and conducted by Evaluator Grace Donato

PUBLIC

COMPLAINT CONTROL NUMBER: 26-AS-20220412110249

FACILITY NAME:	PALM VILLAS, CAMPBELL		FACILITY NUMBER:	435202301
ADMINISTRATOR:	SNEPER, GARRY		FACILITY TYPE:	740
ADDRESS:	3333 SOUTH BASCOM AVENUE		TELEPHONE:	(408) 559-8301
CITY:	CAMPBELL	STATE: CA	ZIP CODE:	95008
CAPACITY:	48	CENSUS: 41	DATE:	01/08/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Myra Belza & Blyth Obien		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff yelled at client

INVESTIGATION FINDINGS:

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This is an amended report.

On 1/08/24, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced visit to deliver findings for the above allegation. LPA met with Office Manager Myra Belza & Resident Services Director Blyth Obien. LPA explained the purpose of the visit.

Regarding the allegation of staff yelled at client, reporting party (RP) observed a staff member who was helping resident drink water and take medication, the staff member yelled at the resident and making repeated accusations.

LPA interviewed five out of five residents and everyone mentioned that they feel well taken care of here. A staff member (S1) who has been here since 2018 was also interviewed and stated that they don’t remember any incident of a staff yelling at a resident. Current staff have started working at the facility since 2023.

Based on observation and interviews, the department has determined that the allegation is UNSUBSTANTIATED, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

The report was reviewed, and a copy is provided.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jackie Jin	TELEPHONE: (714) 319-3786
LICENSING EVALUATOR NAME: Grace Donato	TELEPHONE: 714-293-8294
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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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