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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 08/20/2025
Date Signed: 08/20/2025 12:12:06 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
08/11/2025 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 11-AS-20250811090913
FACILITY NAME:PALMCREST GRAND RESIDENCEFACILITY NUMBER:
198602069
ADMINISTRATOR:GOMEZ, VERONICAFACILITY TYPE:
740
ADDRESS:3503 CEDAR AVENUETELEPHONE:
(562) 595-4551
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:262CENSUS: 141DATE:
08/20/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Veronica GomezTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Licensee does not ensure that staff have criminal clearance
INVESTIGATION FINDINGS:
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On August 20, 2025, Licensing Program Analyst (LPA) Deborah Lee conducted an initial visit to gather information regarding the above allegation. LPA met with Veronica Gomez, Administrator, and the purpose of the visit was explained. LPA was granted entry to the facility.

Investigation consisted of the following:
On 8/20/2025 LPA obtained and reviewed requested Resident Roster (dated 8/12/25), staff roster/Personnel Report (LIC500 – dated 4/2025) checked criminal clearances, and conducted interview with Administrator (A1).
Investigation revealed the following:

Allegation: Licensee does not ensure that staff have criminal clearance

The detail of the complaint alleges that a “staff is working underneath his cousin’s name” and that this alleged staff is not criminally cleared.
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Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
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-20250811090913
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: 08/20/2025
NARRATIVE
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On 8/20/25, at 10:15 am. LPA Lee interviewed Veronica Gomez (A1), who denied the allegation stating that all staff are criminally cleared and associated to the facility. LPA was able to confirm that there are no employees by the names indicated in the complaint currently on staff at the facility. LPA confirmed this by reviewing the staff roster and Licening Information System (LIS) personnel report.

On 8/20/2025, from 10:30am-12:00pm, LPA Lee conducted a review of the Personnel Report LIC 500 (dated 4/2025). During this review, all staff members were cross-referenced using the Licensing Information System (LIS) and the Community Care Licensing Guardian System. The results confirm that all staff members have obtained Criminal Record Clearance.

Based on record review and interview conducted, there is insufficient information to support the above allegation.

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 UNSUBSTANIATED

No deficiencies cited during today's visit.

Exit interview conducted and copy of report provided to Veronica Gomez, Administrator.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 08/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2025
LIC9099 (FAS) - (06/04)
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