198603892-4-30-2026-28-AS-LHIS-DU4PQJ-20260515113110

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603892
Report Date: 04/30/2026
Date Signed: 04/30/2026 03:04:28 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/24/2026 and conducted by Evaluator Jewel Baptiste

COMPLAINT CONTROL NUMBER: 28-AS-20260424165258

FACILITY NAME:	PALOMINO RESIDENTIAL CARE		FACILITY NUMBER:	198603892
ADMINISTRATOR:	PALOMINO, BORIS		FACILITY TYPE:	740
ADDRESS:	1401 PIEDRA WAY		TELEPHONE:	(323) 353-1167
CITY:	MONTEREY PARK	STATE: CA	ZIP CODE:	91754
CAPACITY:	6	CENSUS: 5	DATE:	04/30/2026
		UNANNOUNCED	TIME BEGAN:	11:33 AM
MET WITH:	Administrator Amanda Palomino		TIME COMPLETED:	03:18 PM

ALLEGATION(S):

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Staff do not accord privacy to resident in care.

INVESTIGATION FINDINGS:

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On 04/30/26, Licensing Programming Analyst (LPA) Jewel Baptiste conducted an unannounced complaint investigation at the facility listed above. Upon arrival, LPA met with Amanda Palomino (Administrator) and explained the purpose of the visit.

During the visit, LPA obtained the resident roster, staff roster, visiting policy, Advanced care directive form for R1, Letter from R1’s Advanced care directive designee, R1’s family living trust, and R1’s admission agreement. LPA toured the facility with the Administrator. Three (3) administrators and two (2) staff members were interviewed and shall be referred to as the Administrator (Admin.) and Staff #1 through Staff #4 (S1-S4). LPA also interviewed a total of 6 residents, who shall be referred to as residents #1 through #6 (R1-R6). LPA also interviewed the person responsible for R1, who shall be referred to as W1.

Report continued on 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
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)

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Control Number 28-AS-20260424165258

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PALOMINO RESIDENTIAL CARE	FACILITY NUMBER: 198603892
	VISIT DATE: 04/30/2026

NARRATIVE

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The investigation reveals the following: Regarding "Staff do not accord privacy to residents in care," it is alleged that facility staff listen in on R1's conversations with visitors. According to the Administrator, all residents have the option to visit with their families and friends in their rooms, the common area, or the backyard. 4 out of 4 staff denied listening in on the residents' conversations. They also stated that they have the option to go to their rooms during family visits. R1 refused to talk and wanted to sleep. R3 through R6 stated that they like living at the facility and have always been afforded privacy during family or friends’ visits. Due to R2’s diagnosis, LPA could not use their interview. LPA notices there are cameras in common areas, but they do not have audio to listen to the residents' conversations.

Based on LPA's interviews, the investigation revealed that, although the allegation may have occurred or be valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur; the allegation is UNSUBSTANTIATED.

An exit interview was conducted with Amanda Palomino, and a copy of this record was provided.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Jewel Baptiste
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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