306006071-7-5-2023-22-AS-AORZ-CU2SSE-20230724140749

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 07/05/2023
Date Signed: 07/05/2023 09:59:41 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 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
04/05/2022 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220405132859

FACILITY NAME:	PALMS RETIREMENT CENTER		FACILITY NUMBER:	306006071
ADMINISTRATOR:	BARRIENTOS, ELEANOR		FACILITY TYPE:	740
ADDRESS:	312 N ROOSEVELT AVE		TELEPHONE:	(626) 353-4710
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92832
CAPACITY:	144	CENSUS: 109	DATE:	07/05/2023
		UNANNOUNCED	TIME BEGAN:	09:10 AM
MET WITH:	Assistant Administrator, Kathleen Tamondong		TIME COMPLETED:	10:05 AM

ALLEGATION(S):

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Resident was raped by another resident.
Staff does not provide adequate supervision.
Facility has vermin.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre met with Assistant Administrator Kathleen Tamondong for the purpose of delivering the findings for the above allegations. The investigation consisted of interviews conducted and medical records obtained. On 04/05/2022, the department received allegations that Resident was raped by another resident, Facility Staff does not provide adequate supervision, and Facility has vermin. The investigation was completed by the Department and revealed the following:

On 4/04/2022 Resident 1 (R1) was transported to the hospital due to R1 complaining of vaginal pain and discomfort. At the time of incident, R1 reported to facility staff that an unknown male had been “all up in that” while pointing to her genitals. It was reported to Administrator Katherine Trevino by Staff (S1) that blood was discharged on R1’s undergarments. Interviews conducted and Medical Records revealed that R1 was diagnosed with a Complicated Urinary Tract Infection (UTI). Medical Records noted that R1 underwent additional tests and was examined by physicians for additional medical diagnoses. Based off Medical Records there was no information reporting any suspicion of sexual abuse. CONTINUED 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/05/2023

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 22-AS-20220405132859

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PALMS RETIREMENT CENTER	FACILITY NUMBER: 306006071
	VISIT DATE: 07/05/2023

NARRATIVE

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R1 was discharged from the hospital on 4/08/22 with antibiotic medication and follow up orders to return or go to the Emergency room if symptoms worsen. Although R1 had vaginal discomfort and bleeding due to a UTI, the evidence does not support Neglect/Lack of Care and Supervision leading to the Resident being sexually abused deeming the allegation of Resident was raped by another resident to be UNSUBSTANTIATED. Based off interviews and medical records, although the allegations may have happened or is valid there is no preponderance of evidence to prove the alleged violations did or did not occur.

Investigation revealed that regarding the allegation Staff does not provide adequate supervision, 6 out of 9 residents interviewed believe that facility has been doing a good job of care and supervision of residents. Interviews revealed that facility is providing residents with meals, clean clothing/linen, medications and transportation. 8 out of 9 residents claim that facility is monitoring residents as they exit facility deeming the allegation Staff does not provide adequate supervision UNSUBSTANTIATED. Although the allegations may have happened or is valid there is no preponderance of evidence to prove the alleged violations did or did not occur.

Based off interviews conducted investigation revealed that 6 out of 9 residents confirmed that facility has had vermin such as cockroaches inside and outside of facility grounds. During visits LPA inspected 4 resident rooms, facility dining room, facility lobby, Administrator office, laundry room, activities room, media room and first & second floor hallways and did not observe any vermin or insects. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation Facility has vermin is UNSUBSTANTIATED.

An exit interview was conducted with Assistant Administrator and a copy of this report along with appeal rights was left at facility.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 07/05/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2023

LIC9099 (FAS) - (06/04)

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