198602069-12-9-2024-11-AS-SCIS-DD7UE7-20250123143040

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 12/09/2024
Date Signed: 12/09/2024 04:24:38 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
10/14/2024 and conducted by Evaluator Elvira Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20241014104942

FACILITY NAME:	PALMCREST GRAND RESIDENCE		FACILITY NUMBER:	198602069
ADMINISTRATOR:	GOMEZ, VERONICA		FACILITY TYPE:	740
ADDRESS:	3503 CEDAR AVENUE		TELEPHONE:	(562) 595-4551
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90807
CAPACITY:	262	CENSUS: 144	DATE:	12/09/2024
		UNANNOUNCED	TIME BEGAN:	11:27 AM
MET WITH:	Peggy Clark		TIME COMPLETED:	04:06 PM

ALLEGATION(S):

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Facility staff speaking inappropriately to resident in care.
Facility staff did not meet the needs of resident in care.

INVESTIGATION FINDINGS:

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On 12/09/2024, the department conducted a subsequent complaint visit to further investigate the allegations listed above and deliver findings. The department met with Administrator Peggy Clark and the purpose of today’s visit was explained.

The investigation consisted of the following: On 10/21/24, the department requested and obtained copies of the staff roster, resident roster, and face sheet, physicians report, preplacement appraisal information, needs and service plan, personal rights, and incidents reports for residents #1 (R1). Additionally, the department conducted interviews with Administrator (A1), residents #1-#12 (R1-R12) and conducted a tour of the facility. On 12/09/24, the department interviewed staff #1-#5 (S1-S5).

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20241014104942

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: 12/09/2024

NARRATIVE

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The investigation revealed the following:

Allegation: Facility staff speaking inappropriately to resident in care. It is alleged that staff told resident, that if they didn’t start behaving, they would send the client away.

On 10/21/24, the department conducted interviews with A1, S1-S,5 and R1-R12. 6 out of 6 staff interviewed denied the allegation. 6 out of 6 staff interviewed stated all residents are treated with respect.

11 out of 12 residents interviewed denied the allegation. 10 out of 12 residents interviewed stated that facility staff treat them with dignity and respect. 11 out of 12 residents interviewed stated they are satisfied with the facility and the services being provided to them.

Based on the observation, a review of records, and interviews conducted, there was not enough evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation: Facility staff did not meet the needs of resident in care. It is alleged that a resident asked staff for assistance back to their room after eating breakfast. Staff left resident unattended and without assistance in the TV room.

On 10/23/24, the department conducted interviews with A1, S1-S5, and R1-R12. 6 out of 6 staff interviewed denied the allegation.

11 out of 12 residents interviewed stated they did not know of the allegation. 11 out of 12 residents interviewed stated that staff assist them with their everyday needs. 11 out of 12 residents interviewed stated they are satisfied with the facility and the services being provided to them.

Based on the observation, a review of records, and interviews conducted, there was not enough evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted with Administrator Peggy Clark, and a copy of this report was provided.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Elvira Gonzalez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024

LIC9099 (FAS) - (06/04)

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