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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208915
Report Date: 04/14/2023
Date Signed: 04/25/2023 02:28:09 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/09/2023 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20230109154022
FACILITY NAME:PALMS AT SAN LAUREN, THEFACILITY NUMBER:
157208915
ADMINISTRATOR:RICE, DOUGLASFACILITY TYPE:
740
ADDRESS:5300 HAGEMAN RDTELEPHONE:
(661) 218-8333
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY:68CENSUS: DATE:
04/14/2023
UNANNOUNCEDTIME BEGAN:
12:19 PM
MET WITH:Doug Rice, Administrator TIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not administer resident's medication in a timely manner
Staff are intimidating resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 04/14/23, Licensing Program Analyst, (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegations. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility.

During the investigation, LPA toured the facility and Resident R1's room, conducted interviews and records review. LPA interviewed R1 who denies feeling intimidated by any staff. R1 stated they believe staff speak loudly because it is common that the residents in the facility experience hearing loss. LPA observed R1's Medication Administration Records and Centrally Stored Medication and Destruction Record to accurately reflect the medication doses have been given according to physician's order.

Based on the information received, we have found that the complaint was Unfounded, meaning that the allegations are false, or are without reasonable basis, therefore, we have dismissed the complaint. Exit interview conducted with Administrator and a copy of this report was provided at the time of visit. No deficiencies cited.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023
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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