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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 09/12/2022
Date Signed: 09/12/2022 02:43:24 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, 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
09/07/2022 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20220907081744
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: 119DATE:
09/12/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:ADMINISTRATOR PEGGY CLARKTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff did not make snacks available to residents in care
Staff did not allow residents to participate in planned activities
INVESTIGATION FINDINGS:
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On 09/12/2022 around 09:00 AM Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. Today’s complaint investigation was conducted face to face with Administrator (S1).

The Investigation consisted of the following: On 09/12/2022 LPA Calderon interviewed (S1) and conducted a tour of the physical plant. LPA Calderon obtained copies of Staff and Resident rosters, snack menu, activity calendar for September 2022, copy of activity director resume. On 09/09/2022 LPA Calderon attempted to interviewed W1 regarding complaint, but due to no information on W1 no interview was done. On 09/12/2022 LPA Calderon interviewed R1-R10 for complaint and on 09/12/2022 LPA Calderon interviewed S2-S5 for complaint.

The investigation revealed the following:
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: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
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-20220907081744
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: 09/12/2022
NARRATIVE
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Allegation 1: Staff did not make snacks available to residents in care. On 09/09/2022 LPA Calderon attempted to interviewed W1, but due to no contact information for witness no interview could be obtained. On 09/12/2022 LPA Calderon interviewed R1-R10 who state snacks are given to all residents before activities are done or passed out by staff who comes to their room. Residents state that at no time has staff refused to give them a snack and they are given a calendar every month to advise what snack will be given each day. On 09/12/2022 LPA Calderon interviewed S1-S5 who state that no staff would deny a resident a snack which is provided prior to the daily activity or passed out at their rooms. Staff states that the activity director passes out a snack and activity calendar evert month and residents know what snack will be provided, some residents refuse the daily snack. On 09/12/2022 LPA Calderon reviewed September 2022 activity/snack calendar. The calendar which is passed out to all residents shows what snack will be passed out to residents.

Allegation 2: Staff did not allow residents to participate in planned activities. On 09/09/2022 LPA Calderon attempted to interview W1 but do to no information for W1 no statement could be taken. On 09/12/2022 LPA Calderon interviewed R1-R10 who state that staff hands them a copy of the monthly activity calendar and that most residents attend at the activity room. Residents state that no staff has ever denied them access to the activity room or denied them the opportunity to do the daily activity with other residents. Residents have never seen or heard of any staff denying access to the daily activity. On 09/12/2022 LPA Calderon interviewed S1-S5 who state that S5 who is the activity director passes out the month calendar and would never deny access to residents if they would like to do the daily activity. On 09/12/2022 LPA Calderon reviewed the activity calendar for September 2022, which is posted in the activity room and LPA Calderon also found a copy in the resident’s room. LPA Calderon also reviewed S5 resume and noted that S5 is qualified to be the director for activities.

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 exit interview was conducted with Administrator S1, and a hard copy was provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 09/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2