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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015601167
Report Date: 02/27/2025
Date Signed: 02/27/2025 05:55:35 PM

Document Has Been Signed on 02/27/2025 05:55 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PALM TREE COURTYARDFACILITY NUMBER:
015601167
ADMINISTRATOR/
DIRECTOR:		JULIANA TABURAZAFACILITY TYPE:
740
ADDRESS:550 DEAN STREETTELEPHONE:
(510) 538-7428
CITY:HAYWARDSTATE: CAZIP CODE:
94541
CAPACITY: 15CENSUS: 9DATE:
02/27/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:50 PM
MET WITH:Sheilha Muniz/Business Office Manager
and Juliana Taburaza/Administrator		TIME VISIT/
INSPECTION COMPLETED:
06:00 PM
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On this day, 2/27/25, at 3:50 pm, Licensing Program Analyst (LPA) Delmundo arrived unannounced to continue the annual required inspection that was started on 2/20/25. LPA met with Sheilha Muniz, business office manager (BOM), and informed the reason for visit. LPA also met with Juliana Taburaza, administrator (ADM).

LPA reviewed 5 residents and 5 staff files. Residents medications were checked and compared with doctor's orders and LIC622 Centrally Stored Medication and Destruction Records. Residents' P&I were checked and compared with last recorded balance.

No deficiency observed during today's inspection.

Exit interview conducted and copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Alicia Delmundo
LICENSING EVALUATOR SIGNATURE: DATE: 02/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/27/2025
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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