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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 08/20/2020
Date Signed: 04/26/2021 03:19:58 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/10/2020 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20200610131541
FACILITY NAME:PALMCREST GRAND RESIDENCEFACILITY NUMBER:
198602069
ADMINISTRATOR:STREICHER, RACHELFACILITY TYPE:
740
ADDRESS:3503 CEDAR AVENUETELEPHONE:
(562) 595-4551
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:262CENSUS: 107DATE:
08/20/2020
UNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:ASST ADMIN PEGGY CLARKTIME COMPLETED:
03:16 PM
ALLEGATION(S):
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Staff are stealing resident's personal property.
INVESTIGATION FINDINGS:
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On 06/10/2020 Licensing Program Analyst LPA Kourtney Williams conducted a complaint investigation for the allegation listed above. In accordance with Governor's Proclamation has set forth, LPA is unable to make a physical inspection due to COVID-19. Today’s investigation was conducted by telephonically with Peggy Clarke, Assistant Administrator.

The Investigation consisted of the following: On 08/21/2020 LPA Kourtney Williams interviewed Administrator S1 Russell and interviewed S2 – S10. On 08/21/2020 LPA Williams interviewed R1 – R10 for complaint.

The investigation revealed the following:

Allegation: Staff are stealing resident's personal property.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/19/2020
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 11-AS-20200610131541
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: PALMCREST GRAND RESIDENCE
FACILITY NUMBER: 198602069
VISIT DATE: 08/20/2020
NARRATIVE
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It is alleged Staff are stealing resident's personal property. On 08/21/2020 LPA Williams interviewed administrator S1 Russell has not received any reports from staff or residents regarding the theft of any personal property or money and that there is video that covers the hall ways to residents’ room. On 08/21/2020 LPA Williams interviewed R1 – R10, all residents feel safe living at the facility and have never had any personal property stolen or any money missing.

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.

A telephonic exit interview was conducted with Administrator Peggy Clark, and a hard copy was provided via email for records.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2