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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 496803300
Report Date: 04/17/2025
Date Signed: 04/17/2025 02:07:24 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
01/21/2025 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20250121095733
FACILITY NAME:FIVE PALMS CARE HOMEFACILITY NUMBER:
496803300
ADMINISTRATOR:ROBERTSON CIRINEOFACILITY TYPE:
740
ADDRESS:1217 LANCE DRIVETELEPHONE:
(707) 579-1739
CITY:SANTA ROSASTATE: CAZIP CODE:
95401
CAPACITY:23CENSUS: 15DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
08:54 AM
MET WITH:Josephine Credo (Licensee)TIME COMPLETED:
02:22 PM
ALLEGATION(S):
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-Staff yell at resident.
-Staff raised arm to resident in a threatening manor.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and deliver findings regarding the above allegations and met with Licensee Josephine Credo.

The Department received an allegation of staff yell at resident, staff raised arm to resident in a threatening manner. Per Reporting party, resident (R1) has mentioned that staff (last name unknown) yells at them and swung their arm at R1 like if they were going to hit the resident. Based on interviews conducted by LPA with residents (R1, R2, R3, R4, R5, R6, R7 & R8) and staff (S1, S2 & S3) revealed some conflicting information regarding who mostly yells at the house are some residents (no names were provided), but their statements were consistent about no witnessed or observation of any staff yelling, raising their voice or their arms in a threatening manner to the residents in care. Residents indicated that they feel safe at the home, and they are not afraid of people at the house. Staff denied yelling and raising their arms at residents including R1.
Continue on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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 2
Control Number 21-AS-20250121095733
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: FIVE PALMS CARE HOME
FACILITY NUMBER: 496803300
VISIT DATE: 04/17/2025
NARRATIVE
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Continued from LIC9099...

Based on records review, R1 did not seek medical treatment after the alleged incident nor appear to have any bruising or marks indicating any physical abuse. Also, LPA obtained police records # SR250210082 concluded that the suspected abuser was another resident and not staff. A finding that the complaint allegation occurs of staff yell at resident, staff raised arm to resident in a threatening manner is unsubstantiated meaning that although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2