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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 03/13/2024
Date Signed: 03/13/2024 05:17:48 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/04/2024 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240304121803
FACILITY NAME:PALMCREST GRAND RESIDENCEFACILITY NUMBER:
198602069
ADMINISTRATOR:PEGGY CLARKFACILITY TYPE:
740
ADDRESS:3503 CEDAR AVENUETELEPHONE:
(562) 595-4551
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:262CENSUS: 133DATE:
03/13/2024
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Veronica Gomez, AdministratorTIME COMPLETED:
05:21 PM
ALLEGATION(S):
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Staff did not ensure that resident's room was free of tripping hazards.
INVESTIGATION FINDINGS:
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On 03/13/24 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the above-mentioned facility. LPA was met by Veronica Gomez, Administrator (S1) ,and the purpose of the visit was explained. LPA toured the facility.

The investigation consisted of the following:
On 03/13/24 LPA requested and reviewed facility documents and toured the facility. LPA interviewed ten (10) out of one-hundred thirty-three (133) residents and four (4) out of seventy-two (72) staff.
The investigation revealed the following:
Regarding the allegation: "Staff did not ensure that resident's room was free of tripping hazards.". It has been alleged that staff have not moved resident one (R1) to a room without a tripping hazard. LPA interviewed four (4) staff (S1-S4). All staff have agreed that the ALW program's personal rooms have got a step to get into the showers, or have a cut-out in the bathtub for a resident to get in the tub, which also requires a step to allow a resident to shower, therefore denying the allegation.
Report continues, see LIC9099C
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024
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 3
Control Number 11-AS-20240304121803
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: PALMCREST GRAND RESIDENCE
FACILITY NUMBER: 198602069
VISIT DATE: 03/13/2024
NARRATIVE
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LPA observed three ALW personal rooms, all of which have a step to get in the shower.
LPA interviewed 10 residents (R1-R10), seven (7) out of ten (10) residents have denied the allegation, one (1) resident out of ten (10) have denied the interview. LPA interviewed one (1) witness (W1) from Carelon Hospice and W1 has provided sufficient information to deny R1's fall was based on over-medication or any abuse.

Record reviews revealed that resident one ambulated to the hospital via taxi service and that the radiology department observed no fractures throughout R1's body.

Based on LPA's observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

No deficiencies were cited during today's visit.

An exit interview was conducted with Veronica Gomez, Administrator (S1), and a copy of this report has been provided.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3