<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191800001
Report Date: 02/26/2026
Date Signed: 02/26/2026 09:23:18 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/19/2025 and conducted by Evaluator Luis DeLeon
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20251119132345
FACILITY NAME:HOLLENBECK PALMSFACILITY NUMBER:
191800001
ADMINISTRATOR:DIANA MEDINAFACILITY TYPE:
741
ADDRESS:573 S. BOYLE AVETELEPHONE:
(323) 263-6195
CITY:LOS ANGELESSTATE: CAZIP CODE:
90033
CAPACITY:185CENSUS: 156DATE:
02/26/2026
UNANNOUNCEDTIME BEGAN:
08:37 AM
MET WITH:Administrator Diana MedinaTIME COMPLETED:
09:45 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not distributing resident's medication as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
*** This licensing report supersedes the licensing report dated 11/24/25. The licensing report is being reissued to clarify information obtained during the investigation; however, the findings remain the same***

On today’s visit, Licensing Program Analysts (LPA) Luis De Leon conducted an subsequent unannounced complaint investigation visit for the allegation listed above. LPA met with Administrator Diana Medina and explained the reason for the visit.

During the 11/24/25 visit, LPAs Ellena Mallett and Luis De Leon toured the physical plant with assistance of Assisting Living Coordinator Odily Franklin. LPA’s obtained the current client and staff roster, and R1s Admission Agreement, Physician’s Report, Physician’s Order, MARs log, Needs and Service Plan, Stored Medication and Destruction Record.

Report continues on page LIC-9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026
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 28-AS-20251119132345
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: HOLLENBECK PALMS
FACILITY NUMBER: 191800001
VISIT DATE: 02/26/2026
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding allegation: Staff are not distributing resident's medication as prescribed.

It is alleged that the facility is not properly distributing residents in care with prescribed medication. The investigation reveals the following: Interview with ten (10) out of ten (10) residents denied the above allegation. All residents stated that staff have not ever missed any medication. One (1) of ten (10) residents has observed staff coming to dining area to distribute prescription medications to residents, and reported that staff are conscientious about medications and give R1’s spouse medication as needed. One (1) of Ten (10) residents stated that residents complain about food, but the resident has never heard any complaints about prescription medications not being administered to residents by staff. LPAs interviewed W1 who stated that staff have responded to R1’s call for assistance for activities of daily living (ADLs) in a timely manner. In addition, W1 stated that staff have never forgotten to give R1’s prescribed medication. Interviews with staff revealed that ten (10) out of ten (10) staff denied above allegation. Interview with staff revealed that staff follow medication procedure where staff have a two-hour window before and after the prescription is scheduled to be administered to residents. Staff try to locate residents by phone or search in common areas. If resident is not located, charge nurse is notified and charge nurse reports it to doctor for missed medication. S1 stated that after two-hour window, the prescribed medication is destroyed and missed residents medication is documented in the Stored Medication and Destruction Record. S1 stated that medication is destroyed in order to prevent Med Tech confusion and to prevent residents from receiving double doses for the next scheduled medication time. Staff stated that residents who are going to be absent from facility are given prescriptions medications to take with them, and family is instructed to distribute the prescription medication to residents. LPAs reviewed three (3) residents’ prescriptions medications and did not find any health and safety risks to residents in care. Based upon the investigation, client and staff interviews, document review, and LPA observations, the facility is distributing resident’s medication as prescribed.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview held with Administrator Diana Medina. A copy of the report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Luis DeLeon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2