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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 05/21/2025
Date Signed: 05/21/2025 11:52:21 AM

Unfounded


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
05/15/2025 and conducted by Evaluator Michael Tea
COMPLAINT CONTROL NUMBER: 22-AS-20250515082023
FACILITY NAME:PALMS RETIREMENT CENTERFACILITY NUMBER:
306006071
ADMINISTRATOR:BARRIENTOS, ELEANORFACILITY TYPE:
740
ADDRESS:312 N ROOSEVELT AVETELEPHONE:
(626) 353-4710
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY:144CENSUS: 107DATE:
05/21/2025
UNANNOUNCEDTIME BEGAN:
08:36 AM
MET WITH:Khatera Bahadory & Kathleen TamondongTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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- Staff are not giving resident's belongings to resident after resident left the facility
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Michael Tea made an unannounced visit to conduct a complaint investigation. LPA Tea was greeted and granted entry by facility staff and explained the reason for the visit. Assistant Administrator (AA) Kathleen Tamondong and (ED) Khatera Bahadory arrived shortly to assist with the visit.

The department received a complaint on May 15, 2025 and LPA Tea conducted the initial 10 day visit a week later on May 21, 2025. It was alleged that facility staff are not giving resident’s belonging to resident after resident left the facility. LPA Tea interviewed facility staff and collected pertinent documents such as staff and resident rosters, copies of Resident 1 (R1)’s file. The investigation determined the following:

Report continued on LIC9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
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 22-AS-20250515082023
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: PALMS RETIREMENT CENTER
FACILITY NUMBER: 306006071
VISIT DATE: 05/21/2025
NARRATIVE
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Per review of admission agreement, “Belongings Removal” section, In the event of a resident’s death or any way vacating of premises, facility will make responsible efforts to assist resident and/or responsible person with belonging removal. Facility requires all resident personal belongings to be removed within five days. Also, in the admission agreement the facility is not responsible for storing resident belongings. R1 has left the facility since April 30, 2025 to a new facility, and R1’s belongings has been here for almost a month, well past five days. The facility has been gracious to keep R1's belongings past the grace period.

Per interviews with assistant administrator and Executive Director, the facility has never withheld R1’s belongings. R1 and their responsible party can pick up R1’s belongings anytime. The facility has also said they do not have contracts, promissory notes to arrange or pay for arrangements for belongings to be moved, it’s the sole responsibility of the resident or responsible party to move their belongings. Assistant Administrator and Executive Director said they have not touch R1’s belongings and left it the way R1 left it when they moved to the other facility. Based on LPA’s observations, LPA Tea toured R1’s former room and notice a closet full of miscellaneous items and several big plastic tubs and a lot of personal grooming items and fast-food drink cups on top of the facility dresser. All items are left untouched. R1 had also left a refrigerator. The facility hopes R1 and responsible party would pick up the items so they can have a bed available for a future resident. Out of respect for R1 they do not touch or move the items or throw it out. AA Tamongdong has said the facility has offered help to organize R1’s belongings. ED Bahadory also noted that when the other facility came to pick up R1, they said they would come back and pick up the rest of R1’s belongings.

The facility has called and left several messages for R1’s primary responsible party and emailed. There has never been a response from them. Facility provided copies of emails sent to the responsible party of R1 prior and after R1 moving regarding facility placement and what to do with R1’s belonging. LPA did try to reach out R1’s primary responsible party and did not get any response as well. LPA did spoke to R1’s other brother who is not the primary responsible party and admitted that it was hard to get a hold or responses from the primary responsible party. And their other brother who lives in California does not have space permitted for R1’s belongings. They will try to reach out to R1 to see if they can arrange something or a possible solution.

Report continued on LIC9099-C
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250515082023
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: PALMS RETIREMENT CENTER
FACILITY NUMBER: 306006071
VISIT DATE: 05/21/2025
NARRATIVE
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Therefore, based on LPA Tea's observations and interviews conducted and records reviewed the allegation that facility staff are not giving resident’s belonging to resident after resident left the facility has been determined as UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis.

No deficiencies cited at this time and an exit interview was conducted with Executive Director Khatera Bahadory and Assistant Administrator Kathleen Tamondong. A copy of the report and confidential names list was provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 05/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3