486803728-3-26-2026-21-AS-KMOA-DSRLQB-20260402085714

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803728
Report Date: 03/26/2026
Date Signed: 03/26/2026 02:48:59 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/25/2026 and conducted by Evaluator Anthony Loera

COMPLAINT CONTROL NUMBER: 21-AS-20260225081204

FACILITY NAME:	PALM VIEW RETREAT		FACILITY NUMBER:	486803728
ADMINISTRATOR:	HARRIS, DAE'JANIQUE		FACILITY TYPE:	735
ADDRESS:	150 BROADWAY STREET		TELEPHONE:	(707) 652-2624
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94590
CAPACITY:	32	CENSUS: 32	DATE:	03/26/2026
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Administrator, Dae'Janique Harris Associate Director, Ebony Taylor		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Staff do not ensure arrangements are made for client to attend medical appointments
Staff do not ensure medications are dispensed as prescribed

INVESTIGATION FINDINGS:

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On 03/26/2026, Licensing Program Analyst (LPA) Loera conducted an unannounced visit for the purpose of delivering complaint findings regarding the above allegations. LPA arrived and met with Administrator, Dae'Janique Harris and Associate Director, Ebony Taylor. During the investigation, LPA conducted interviews, reviewed documents and made observations.

Compliant alleges, staff do not ensure arrangements are made for client to attend medical appointments and staff do not ensure medications are dispensed as prescribed.

During the course of the investigation, LPA was unable to gather information to support the allegations as LPA was provided with conflicting information. Complainant stated staff have not taken client (C1) to their injection appointments since November 2025. LPA was informed by facility C1 goes to a clinic to get injections once a month, as facility does not give injections.

continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

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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Control Number 21-AS-20260225081204

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SANTA ROSA RO, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: PALM VIEW RETREAT	FACILITY NUMBER: 486803728
	VISIT DATE: 03/26/2026

NARRATIVE

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Interview with outside party revealed C1 last received their injections on 11/26/2025 and was scheduled to get their next injection on 12/28/2025 but the facility called on 12/23/2025 to cancel and was rescheduled for 12/29/2025, which C1 did not show up for. Interview conducted with two out of two staff stated they did not call on 12/23/2025 to cancel an appointment or receive a call from the clinic to reschedule the appointment at any time during the month of December. Staff stated when C1 goes to their injection appointment they leave with a reminder slip for their next appointment. Staff stated C1 did not receive an appointment slip reminder after their appointment in November 2025. Interview with outside party stated that the facility did receive an appointment slip reminder on 11/26/2025. Outside party was unable to give a staff members name as to who from the facility called to cancel the appointment on 12/23/2025 and who was given the appointment slip reminder on 11/26/2025. Interview conducted with C1 stated “I don’t know, I just haven’t” when asked how come they haven’t gone to their injection appointment since November 2025. C1 also stated in the interview they never did get an appointment slip reminder. There is no documentation from the clinic to show that C1 did receive an appointment slip. During the investigation, LPA was informed by outside party of a conversation held on 2/25/2026 to discontinue C1s injections.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC9099 (FAS) - (06/04)

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