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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803728
Report Date: 04/29/2025
Date Signed: 04/29/2025 03:09:27 PM

Substantiated


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
04/01/2025 and conducted by Evaluator Anthony Loera
COMPLAINT CONTROL NUMBER: 21-AS-20250401165051
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: DATE:
04/29/2025
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Administrator, Dae'Janique HarrisTIME COMPLETED:
03:25 PM
ALLEGATION(S):
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Staff do not ensure client is allowed to leave the facility
INVESTIGATION FINDINGS:
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On 04/29/2025, Licensing Program Analyst (LPA) Loera conducted an unannounced visit for the purpose of delivering complaint findings. LPA arrived and met with Administrator, Dae'Janique Harris. During the investigation, LPA reviewed records, conducted interviews, and made observations.

Compliant alleges, Staff do not ensure client is allowed to leave the facility.

Based on LPAs observations, record reviews, and interviews which were conducted, the following determination have been made, facility has a “pass” and “no pass” list, where clients are placed upon on their behavior and/or drug test results. New clients are put on a 30 day “black out” which means they are unable to leave the facility for their first 30 days. When new clients arrive at the facility, they are told about house rules and are verbally told about the “pass” “no pass” and “black out” system.

Continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
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-20250401165051
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: 04/29/2025
NARRATIVE
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Facilities admission agreement under section House Rules/Facility Policies on page 9, number 13. States, when leaving the facility, the administrator or staff must be informed and advised of expected time of return. A sign-out and sign-in log will be available. In the Facilities Program Plan under Admission Policies; Interview Process on page 55. States “potential clients will be interviewed prior to admission at which time facility program and house rules will be explained during the interview process and determination will be made that the facility program can meet the needs of the individual, and that the individual will be compatible with other clients. There is no way to be sure of this, but the administrator will question the client and find out what the client likes and dislikes and observe as he/she meets the other clients. The interview will provide the prospective client with information about the facility, including the information contained in the Admission Agreement and any additional policies and procedures, house rules, and activities.”

Neither in the admission agreement under House Rules/Facility Polices or in the Facilities Program Plan does it state, notifying clients about the “pass”, “no pass”, and “black out” system and having them agree.

Based on LPAs observations and interviews which were conducted and record reviews the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 1, is being cited on the attached LIC9099D. Appeal rights given.

SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20250401165051
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/08/2025
Section Cited
CCR
80072(a)(6)
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80072 Personal Rights
(a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (6) To leave or depart the facility at any time.
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Facility to update program plan policies regarding house rules for new clients and for clients testing positive/ bad behavior and send to CCL for review by 05/09/2025.
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This requirement was not met as evidenced by: Based on document review, Administrator did not ensure client(s) are able to leave facility per facilities program plan.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Anthony Loera
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2025
LIC9099 (FAS) - (06/04)
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