486803728-9-21-2023-21-AS-KMOA-CW3VC9-20230927161846

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803728
Report Date: 09/21/2023
Date Signed: 09/21/2023 11:12:24 AM

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
08/21/2023 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20230821173350

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: 26	DATE:	09/21/2023
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	LaTrice Tramel		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Staff speaks to resident inappropriately.
Staff forces resident to participate in activities.

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert arrives unannounced for the purpose of delivering findings on this complaint. During the course of the investigation statements were taken from clients, staff, and witnesses. Unannounced site visits were made to the facility and documents were obtained and reviewed. The following determinations are made: Complainant alleges staff force clients to attend group and participate in group outings; Complainant has a medical condition that could make certain group outings difficult; An essential and therapeutic component of the program requires clients to participate in group activities in order to earn privileges such as trips into the community; Random interviews with five clients supports staff claims that clients are not forced to participate in activities but are rewarded with privileges for compliance; Five of five clients state that S1 (staff identified by Complainant) always addresses clients in a respectful manner and conducts activities in a professional way. Although the allegations may be true, based on the statements, reviewed documents, and observations made during site visits, there is not a preponderance of evidence to prove the allegations are or, are not, true. Therefore, the allegations are UNSUBSTANTIATED.
Report left. No citations issued today.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Carla Martinez
LICENSING EVALUATOR NAME: David Leibert
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2023

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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