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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306002008
Report Date: 08/15/2025
Date Signed: 08/15/2025 04:03:20 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/28/2025 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250528121938

FACILITY NAME:PALM VILLAGEFACILITY NUMBER:
306002008
ADMINISTRATOR:LUZVIMINDA BRIMBUELAFACILITY TYPE:
735
ADDRESS:13902 CLINTON ST.TELEPHONE:
(714) 554-8888
CITY:GARDEN GROVESTATE: CAZIP CODE:
92843
CAPACITY:42CENSUS: 35DATE:
08/15/2025
UNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Luzviminda Brimuela-AdministratorTIME COMPLETED:
04:18 PM
ALLEGATION(S):
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Facility retained over-aged client
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced visit to deliver findings on the above allegation received on May 28, 2025. LPA was allowed entry into the facility and met with Administrator (AD) Luzviminda Brimuela. LPA explained the purpose of the visit.

This Department has investigated the complaint alleging facility retained over-aged client. Regarding the allegation the following was revealed: During the course of the interviews with clients, Client 1 (C1) reported that they are not aware about clients living here that are over the age of 60. During the course of the investigation LPA reviewed documents including the regulation Acceptance and Retention Limitations 85068.4 (g). Per Acceptance and Retention Limitations it states that if acceptance or retention of an individual 60 years of age or older would result in the number of persons 60 years of age or older exceeding...25 percent of the census in facilities with a capacity over six, the licensee must request an exception in order to accept or retain the individual.
CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20250528121938
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PALM VILLAGE
FACILITY NUMBER: 306002008
VISIT DATE: 08/15/2025
NARRATIVE
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The exception request must be made in accordance with Section 80024. The documentation specified in Section 85068.4(c) must be submitted with the exception request. During the course of the interviews AD reported that as of today there is only one client who is over the age of 60.

Based on the information gathered during the investigation and review of documents obtained, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.


LPA conducted an exit interview with AD Brimuela, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 08/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4