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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 04/07/2026
Date Signed: 04/07/2026 04:45:34 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
03/30/2026 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20260330112011
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: 97DATE:
04/07/2026
UNANNOUNCEDTIME BEGAN:
09:53 AM
MET WITH:Veronia Gomez/Facility AdministratorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff did not provide adequate supervision to resident in care
INVESTIGATION FINDINGS:
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On 4/7/2026, at approximately 10:00 AM, LPA Alfonso Iniguez conducted an unannounced initial complaint visit. LPA Iniguez met with Veronica Gomez/Facility Administrator. LPA Iniguez explained the purpose of this visit.
Investigation Consisted of: the department conducted the following interviews: Assistant Administrator interview, (A#1), Residents Interviews (R#1-R#8), Witness Interview (W#1) and Staff interview (S#1-S#4). The department gathered the following documents: copy of personnel schedule dated 4/7/26, copy of resident roster dated:4/7/26, copy of (R#1) admission agreement dated: 6/2/2025, copies of facility staff internal incident reports various dates, copy of (R#1) face sheet, copy of (R#1) resident appraisal or LIC 603A dated: 2/18/2026, copy of (R#1) appraisal needs and services plan or LIC 625 dated 2/18/2026, copy of (R#1) physician report for residential care facilities for the elderly (RCFE) or LIC 602A dated:5/30/25 and copies of facility management risk assessment and negotiated risk assessment dated 5/25/25.

Evaluation Report continues LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026
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 4
Control Number 11-AS-20260330112011
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: 04/07/2026
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Investigation Revealed the Following:

Allegation: Staff did not provide adequate supervision to resident in care

The details of the complaint alleged that facility staff are not providing adequate supervision to (R#1)



On April 7, 2026, at approximately 3:00 p.m., during the records review process the department reviewed a copy of (R#1)’s Admission Agreement dated 6/2/2025. The department noted that (R#1)’s personal representative signed for basic services only, which include care and supervision, personal assistance and care, and continuous monitoring and observation. The agreement also states that extra care and supervision are available upon request for an additional charge. The department noted that, in this case, the facility has been providing 1:1 care and supervision to (R#1) without charging (R#1)’s personal representative for the additional service. In addition, the department reviewed copies of the facility’s internal incident reports regarding (R#1), documented on various dates, and noted that the facility has recorded all incidents involving (R#1). The department also reviewed a copy of (R#1)’s Resident Appraisal (LIC 603A) dated 2/18/2026, which indicates that (R#1) requires assistance with transferring in and out of bed, bathing, redirection inside the facility, special diet needs, toileting, continence care, medication assistance, and other services as needed. Moreover, the department reviewed a copy of (R#1)’s Physician’s Report for Residential Care Facilities for the Elderly (LIC 602A) dated 5/30/2025. The department noted that the physician indicated (R#1) has a diagnosis that contributes to their thinking and belief system.

On April 7, during an interview with the facility administrator (A#1), (A#1) stated that the facility provides supervision to residents based on their assessed needs. For residents receiving the basic rate, staff check on them every hour. Residents with higher levels of care are checked every 30 minutes to one hour. (A#1) stated that (R#1) receives one-on-one supervision. in addition, (A#1) further explained that although one-on-one supervision typically requires an additional charge, (R#1)’s family is not paying for this service, and the facility is providing it “out of good faith.” (A#1) stated that (R#1) has one-on-one care and supervision in place and is identified as a fall risk. (A#1) added that (R#1)’s primary physician’s nurse comes to the facility every day to check on her.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20260330112011
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: 04/07/2026
NARRATIVE
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Moreover, (A#1) stated that the facility has a supervisor on every shift. Staff reports all resident events, including incidents involving (R#1), to the shift supervisor, who is responsible for documenting and evaluating the occurrence.

On April 7, during an interview with Witness 1 (W#1), (W#1) stated that during her visits to (R#1), she observed (R#1) in her room with the curtains closed and not participating in daily activities. (W#1) reported finding (R#1) in bed, not fully clothed, wearing only a diaper, and uncovered. (W#1) stated that she asked (R#1) if she was okay, and (R#1) replied, “I’m cold.” (W#1) reported that during one visit, it was already 10:00 a.m., and (R#1) was still in bed and had not eaten anything. (W#1) stated that she typically visits between 10:00 a.m. and 12:00 p.m. once a week. In addition, (W#1) stated that during the times she has visited, she has noticed that facility staff are not available most of the time. (W#1) stated that she is only aware of the conditions she has personally observed during her weekly visits and stated that during those times, she has observed occasions where (R#1) did not appear to be adequately cared for.

On 4/7/26, the department was not able to speak with (R#1) due to their cognitive impairment.

On April 7, during interviews with residents in care (R#2 through R#8), (7) out of (7) residents stated that staff supervise them appropriately. Residents reported that staff “do a very good job” and check on them regularly. All residents interviewed stated that they had never felt they were not being watched, helped, or supervised when needed. In addition, (7) out of (7) residents also reported no issues with staff being unavailable, delayed, or unresponsive, stating that staff are always present to assist them.

On April 7, 2026, during interviews with facility staff (S#1 through S#4),(4) out of (4) facility staff stated that they provide supervision to residents according to their needs, including (R#1), they also reported that their responsibilities include assisting residents with changing clothes, changing diapers, and preparing residents for meals.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20260330112011
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: 04/07/2026
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In addition, they stated that staff consistently provide supervision due to residents’ cognitive impairments and reported that (R#1)’s behavioral expressions require staff to be more aware of her needs and provide close monitoring. Moreover, (4) out of (4) facility staff stated that they have not observed any challenges or gaps in maintaining appropriate supervision for (R#1) or for any other residents in care.

During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of the Complaint Report was given to Veronica Gomez/ Facility Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/07/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/07/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4