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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006071
Report Date: 03/03/2025
Date Signed: 03/05/2025 08:44:56 AM

Document Has Been Signed on 03/05/2025 08:44 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CENTERFACILITY NUMBER:
306006071
ADMINISTRATOR/
DIRECTOR:		BARRIENTOS, ELEANORFACILITY TYPE:
740
ADDRESS:312 N ROOSEVELT AVETELEPHONE:
(626) 353-4710
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY: 144CENSUS: 111DATE:
03/03/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:John Garcia, Facility Manager
Katheleen Tamonding- Administrator Assistant		TIME VISIT/
INSPECTION COMPLETED:
04:05 PM
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Licensing Program Analysts (LPAs) Nancy Guillen and Ruth Martinez made an unannounced visit for the purpose of conducting a required annual Inspection. LPAs were greeted and granted entry by Facility Manager, John Garcia, after explaining the purpose of the visit. Administrator (AD) Eleanor P. Barrientos’s certificate was current and expires June 17, 2025. This is a Residential Care Facility for the Elderly (RCFE) licensed to one hundred forty-four non-ambulatory residents, of which thirty two may be bedridden, with a hospice waiver for ten. The facility is made up of two floors with seventy three resident bedrooms, two staff offices, two laundry rooms, two court yards, a Med room, dinning room, TV lounge, library, balcony, and kitchen.

During the inspection, LPAs, Facility Manager,and Administrator Assistant conducted a tour of the inside and outside of the facility and observed the following:

LPAs observed the See Something Say Something Poster (PUB 475) mounted on the wall by the facility entrance. LPA Guillen began inspection of resident rooms. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the linen closet on the second floor. LPA observed bathrooms were clean and equipped with grab bars and non skid floor mats. LPA observed all windows were appropriately screened. Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 105 and 114 degrees Fahrenheit. LPA Martinez toured the outside of the facility and observed outdoor passageways were free of obstruction. LPA observed the outdoor court yards had a shaded seating area with furniture for resident use.

LIC-809C

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Nancy Guillen
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/03/2025
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LPA Martinez observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide system was checked by Code Red Fire Inc on November 18, 2024 and inspection passed. Sprinkler system was inspected by State Fire Marshall on August 20,2024 and system passed. Egress doors were reportedly tested on February 17, 2025 and were tested throughout the facility by LPA. Fire extinguishers were mounted and located throughout the facility, fully charged with a service date of August 22, 2024. Toxic chemicals, cleaning solutions, and disinfectants were observed to be locked and inaccessible to residents in maintenance storage behind the building. Medication and First Aid kit was observed to be locked and centrally stored in the Med Room. First Aid Kit had all the required components. LPA Martinez observed the facility conducted their last emergency disaster drill on February 5, 2025 and is conducted monthly.

LPA Martinez began review of the records. LPA reviewed eleven resident records. All the required documentation were present and current in the residents’ files reviewed. LPA reviewed nine employee records. All employee’s present have a criminal record clearance and were associated to the facility. LPA observed records reviewed have a current First Aid certificate.



Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Nancy Guillen
LICENSING EVALUATOR SIGNATURE:

DATE: 03/03/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2025
LIC809 (FAS) - (06/04)
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