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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 05/10/2024
Date Signed: 05/10/2024 03:25:39 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, 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
12/19/2023 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20231219134015
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: 132DATE:
05/10/2024
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Administrator - Peggy ClarkTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff speaks to resident in an inappropriate manner.
Staff does not safeguard resident's belongings.
Staff does not treat resident with dignity and respect.
INVESTIGATION FINDINGS:
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On 05/10/2024 Licensing Program Analyst (LPA) Leandro conducted an unannounced, continuation complaint visit to the above-mentioned facility. LPA was met by Peggy Clark, Administrator.

Investigation consisted of the following:
On 12/22/2023 LPA Leon interviewed 6 out of 130 residents and 9 out of 70 staff.
On 05/10/2024 LPA Leandro interviewed 6 out of 132 residents and 2 out of 66 staff.
On 12/22/2023 and 05/10/2024 LPAs requested several facility records.

A total of 12 out of 132 residents were interviewed and a total of 11 out of 66 staff were interviewed.
Record review consisted of: Personnel Report, Facility Census, Unusual Incident/Injury Reports, Facility Staff Trainings, Resident 1’s Records, etc.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
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 2
Control Number 11-AS-20231219134015
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: PALMCREST GRAND RESIDENCE
FACILITY NUMBER: 198602069
VISIT DATE: 05/10/2024
NARRATIVE
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The investigation revealed the following: Regarding the allegation “Staff speaks to resident in an inappropriate manner” it is being alleged that facility staff speak to residents in care inappropriately. 10 out of 12 resident interviews indicated that staff speaks to them appropriately. 8 out of 11 staff interviews indicated that staff speaks to residents appropriately and/or they have not seen staff speak to residents inappropriately. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

The investigation revealed the following: Regarding the allegation “Staff does not safeguard resident's belongings” it is being alleged that facility staff destroy and steal resident belongings. 7 out of 12 resident interviews indicated that they have not had any of their property stolen by facility staff. 9 out of 11 staff indicated that they have not heard of or seen staff stealing/breaking residents’ personal belongings. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

The investigation revealed the following: Regarding the allegation “Staff does not treat resident with dignity and respect” it is being alleged that facility staff mistreat residents in care. 10 out of 12 resident interviews indicated that facility staff treat them with dignity and respect. 10 out of 11 staff interviews indicated that they have not heard complaints and/or seen staff mistreat residents in care. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was left with Peggy Clark, Administrator.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 05/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/10/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2