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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803728
Report Date: 08/17/2023
Date Signed: 08/17/2023 12:53:04 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/15/2023 and conducted by Evaluator Dominic Tobola
COMPLAINT CONTROL NUMBER: 21-AS-20230515095004
FACILITY NAME:PALM VIEW RETREATFACILITY NUMBER:
486803728
ADMINISTRATOR:HARRIS, DAE'JANIQUEFACILITY TYPE:
735
ADDRESS:150 BROADWAY STREETTELEPHONE:
(707) 652-2624
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY:32CENSUS: 26DATE:
08/17/2023
UNANNOUNCEDTIME BEGAN:
11:31 AM
MET WITH:Dae Harris, AdministratorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Staff speaks inappropriate to client in care
Residents are using drugs at the facility
INVESTIGATION FINDINGS:
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On 8/17/2023 Licensing Program Analyst (LPA) Tobola arrived unannounced for the purpose of delivering complaint investigation findings and was greeted by Administrator, Dae Harris. LPA toured the facility, interviewed staff and clients, reviewed client records and made observations.

Complaint alleges staff speak inappropriate to resident in care in violation of resident personal rights. Upon interviews with multiple clients (C1, C2 & C3); all stated that although verbal altercations occur between clients, they have not witnessed staff speaking inappropriately or yelling at clients in care. C3 stated that staff may speak in a stern manner to redirect or provide guidance for clients but not in a demeaning manner. In addition, interviews with staff (S1, S2 & S3) did not indicate any witness to other staff speaking in an inappropriate manner to clients. Due to a lack of corroborating information the allegation is found to be unsubstantiated.

Continued onto LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 21-AS-20230515095004
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405
FACILITY NAME: PALM VIEW RETREAT
FACILITY NUMBER: 486803728
VISIT DATE: 08/17/2023
NARRATIVE
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Complaint alleges residents are using drugs at the facility. Based on interviews with clients (C1, C2 & C3) and staff (S1, S2 & S3), there were no individuals that have witnessed drugs being used within the facility. Staff S2 & S3 indicated that they are responsible for the screening before and after client outings, ensuring that any illegal substances are not brought into the facility. In addition, based on interviews with Administrator and staff (S1, S2 & S3), it was indicated that clients are able to leave the facility unassisted and some of which have a history of substance abuse. Some clients may return to the facility under the influence of substances. In these occasions, Administrator and staff (S1,S2 & S3) informed LPA that the facility conducts drug testing within the facility and transfers clients to a medical center for detoxification and discharged back to the facility once given written medical clearance. Due a lack of corroborating evidence and contradicting information provided, the allegation is found to be unsubstantiated.

Allegations, staff speaks inappropriate to client in care and residents are using drugs at the facility are UNSUBSTANTIATED. A finding that the complaint is unsubstantiated means that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. Appeal Rights given.


No deficiencies cited during visit.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE:

DATE: 08/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3