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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 07/21/2025
Date Signed: 07/21/2025 10:42:21 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/16/2025 and conducted by Evaluator Sean Haddad
COMPLAINT CONTROL NUMBER: 22-AS-20250716163949
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: 109DATE:
07/21/2025
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Khatera BahadoryTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Facility did not refund resident their money
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Administrator (AD) Khatera Bahadory, discussed the purpose of the inspection, and explained the allegation.


The investigation into the allegation that facility did not refund resident their money revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD and residents, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Admission Agreement, and R1’s Billing Statement.

CONTINUED
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
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-20250716163949
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PALMS RETIREMENT CENTER
FACILITY NUMBER: 306006071
VISIT DATE: 07/21/2025
NARRATIVE
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It was alleged that R1 was overcharged and not refunded by $22.58 in fees for basic services. LPA inspected the facility, conducted health and safety checks on residents, and observed no health and safety issues. LPA reviewed R1’s Admission Agreement which indicates R1 moved in on August 15, 2022, R1’s monthly rate for basic services was $1,400, and that prorating of the monthly rate is based on a 30-day month. R1 stated that when they moved in, their $1,400 fee should have been prorated to $700 based on 15 days between August 15 through August 30, 2022 based on the Admission Agreement’s 30-day month prorate rule, but instead their $1,400 fee was prorated to $722.58 based on 16 days between August 15 and through August 31, 2022. LPA reviewed a calendar which confirmed that August 2022 had 31 days in it. Based on the Admission Agreement, R1 was overcharged by $22.58 in August 2022. However, R1 never told the facility about this issue and AD denied ever being notified about this billing issue but was unable to provide documentation regarding how much R1 paid in August 2022. Per AD, R1 is back paid on their monthly fees in the amount of $2,500 and has been back paid on their monthly fees since June 2025. LPA reviewed R1’s Billing Statement which shows that R1 has been back paid on their monthly fees since June 2025 and has a current outstanding balance. While R1 is not entitled to a refund because they have an outstanding balance, they are entitled to a credit of $22.58 on their outstanding balance because the facility made a billing error based on the prorating provision of the Admission Agreement.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250716163949
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PALMS RETIREMENT CENTER
FACILITY NUMBER: 306006071
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/28/2025
Section Cited
CCR
87507(f)
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87507 Admission Agreements … (f) The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. This requirement was not met as evidenced by:
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Licensee stated they will credit R1 by $22.58 and submit proof to LPA by POC due date.
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Based on documents and interviews, the licensee did not follow its admission agreement when it overbilled R1 by $22.58, which poses a potential personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3