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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803728
Report Date: 08/25/2021
Date Signed: 08/25/2021 03:50:39 PM

Document Has Been Signed on 08/25/2021 03:50 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:PALM VIEW RETREATFACILITY NUMBER:
486803728
ADMINISTRATOR:RIDOLFI, ELEINAFACILITY TYPE:
735
ADDRESS:150 BROADWAY STREETTELEPHONE:
(707) 652-2624
CITY:VALLEJOSTATE: CAZIP CODE:
94590
CAPACITY: 32CENSUS: 20DATE:
08/25/2021
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Cecily Palma, Executive DirectorTIME COMPLETED:
12:00 PM
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Regional Manager, Carla Nuti-Martinez, Licensing Program Manager, Kimberley Mota, Licensing Program Analyst Dominic Tobola made contact on this date, via Microsoft Teams with Executive Director, Cecily Palma, Facility Owner, Dinesh Sawhney, Consultant, Rajand Thandi, and Attorney Joel Goldman for the purpose of reviewing issues for Non-Compliance Conference. It is being conducted by tele-visit phone due to COVID-19 precautions. LPA and LPM made subsequent phone call to deliver finalized reports with Executive Director, which were e-mailed for signature.

Due to areas of concern identified by the Department, a Non-Compliance Conference was held. Verbal commitment from Licensee/Administrator was received for Non-Compliance plan during conference. Agreement to receive Technical Support assistance was agreed upon.

Non-Compliance Conference was held to discuss areas of concern including:
  • Drugs are being sold out of the licensed home
  • Client being sexually assaulted while in care
  • Buildings and grounds
  • Insufficient medication supply leading to hospitalization of client

Licensee agreed to TSP service. Compliance Plan will be for two years.

No deficiencies cited during the Non-Compliance Conference.
SUPERVISORS NAME: Kimberley Mota
LICENSING EVALUATOR NAME: Dominic Tobola
LICENSING EVALUATOR SIGNATURE: DATE: 08/25/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/25/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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