<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 07/18/2025
Date Signed: 07/18/2025 03:06:45 PM

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
07/09/2025 and conducted by Evaluator Hanna Gough
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250709151002
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:
07/18/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Khatera BahadoryTIME COMPLETED:
03:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to provide an appropriate bed.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility for the purpose of investigating the above mentioned complaint allegation. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Khatera Bahadory and discussed the purpose of the visit.

The investigation into the allegation Facility failed to provide an appropriate bed revealed the following: LPA observed two pictures that were taken of box springs and mattresses stacked on top of each other with no bedding. LPA observed the resident census list with the shared room occupancies. The room where the mattresses were observed to be stacked has only one resident in care at this time. LPA observed a shared bedroom with one bed unoccupied and not currently being used by any residents. The unused bed was observed to have a bedframe and a box spring. LPA observed the single occupant residing in the room to have a bed, bedframe, box spring and clean linens. LPA observed other resident rooms to have beds, bedframes, linens and box springs throughout the facility. LPA observed an email sent by the AD informing the Department of the renovations on July 9, 2025. Continue on 9099-C
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
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 4
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
07/09/2025 and conducted by Evaluator Hanna Gough
COMPLAINT CONTROL NUMBER: 22-AS-20250709151002

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:
07/18/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Khatera BahadoryTIME COMPLETED:
03:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility provided a mattress that has an odor.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Hanna Gough made an unannounced visit to the facility for the purpose of investigating the above mentioned complaint allegation. LPA was greeted and granted entry by staff. LPA met with Administrator (AD) Khatera Bahadory and discussed the purpose of the visit.

The investigation into the allegation Facility provided a mattress that has an odor revealed the following. Upon interviews with Resident #1 (R1) it was revealed that one of the mattresses that was stacked in their room had an odor that R1 took notice too. R1 informed LPA that due to the construction being taken place on the first floor, they stacked mattresses from resident first floor rooms in the empty space in their room temporarily. R1 informed LPA that the mattresses were not there for long but the odor was strong. During interviews 2 of 2 staff informed LPA that the mattresses and box springs were temporarily placed there while residents were being reshuffled due to the construction that was being done on the first floor. 2 of 2 staff informed LPA that when a mattress has an odor, they throw the mattress away and replace it for the residents in care. Continue on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 22-AS-20250709151002
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: 07/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA observed the resident census list with the shared room occupancies. The room where the mattresses were seen stacked has only one resident in care at this time. LPA observed a shared bedroom with one bed unoccupied and not being used. LPA observed a bed frame and box spring. LPA did not observe a mattress with an odor.

Based on information gathered during the investigation the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred: therefore, this allegation is deemed UNSUBSTANTIATED.

An exit interview was conducted with AD Khatera Bahadory and a copy of this report was left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20250709151002
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: 07/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Upon interviews with Resident #1 (R1) it was revealed that the facility staff stacked the mattresses there for a short time while they were moving residents from the first floor to the second floor due to the construction that was taking place on the first level. R1 did not recall how long the mattresses and box springs were there but stated that they were not there for a long time and have since been removed. R1 informed LPA that no one slept on the stacked mattresses while they were in the room. Upon interviews with 2 of 2 staff revealed that they placed the mattresses and box springs in the room due to needing space while moving residents from the first floor to the second floor temporarily due to the construction that would be taking place. 2 of 2 staff informed LPA that the mattresses and box springs were removed out of the resident’s room and were not stored there. AD informed LPA that since they have been working at the facility, the bed in the room where the stacked mattresses were observed has remained unoccupied with no residents using the stacked beds. LPA observed AD's personnel record that states they started working at the facility on April 1, 2025.

Based on observation, interviews and information gathered during the investigation the preponderance of evidence standard has not been met, therefore the above allegation is deemed UNFOUNDED. Meaning the allegation Facility failed to provide an appropriate bed was false, could not have happened and/or is without a reasonable basis. The department therefore dismissed the complaint.

An exit interview was conducted with AD Khatera Bahadory and a copy of this report was left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Hanna Gough
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4