198602069-4-30-2026-11-AS-EMAZ-DTSSZV-20260505141947

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 04/30/2026
Date Signed: 04/30/2026 02:42:13 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 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: 97	DATE:	04/30/2026
		UNANNOUNCED	TIME BEGAN:	02:25 PM
MET WITH:	Veronica Gomez/Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Staff did not provide adequate supervision to resident in care

INVESTIGATION FINDINGS:

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This report supersedes the report created 4/7/26 and the findings will remain unchanged.
On 4/30/2026, at approximately 2:00 PM, LPA Alfonso Iniguez conducted an unannounced subsequent 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: 04/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026

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 3

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: 04/30/2026

NARRATIVE

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This report supersedes the report created 4/7/26 and the findings will remain unchanged.

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.

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. 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.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026

LIC9099 (FAS) - (06/04)

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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: 04/30/2026

NARRATIVE

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This report supersedes the report created 4/7/26 and the findings will remain unchanged.

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. 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: 04/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/30/2026

LIC9099 (FAS) - (06/04)

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