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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 10/17/2023
Date Signed: 10/17/2023 11:58:16 AM

Unfounded


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
05/31/2023 and conducted by Evaluator Rosie Quiroz
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230531092156
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: 125DATE:
10/17/2023
UNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Erin Rehbein, AdministratorTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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-Staff are not following infectious control plan
INVESTIGATION FINDINGS:
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 On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit for the purpose to conduct additional interviews and deliver findings for complaint allegations listed above. LPA Quiroz was greeted by front desk receptionish and met with Administrator (AD) Erin Rehbein and discussed purpose of today's visit. The 10 day visit was conducted on 6/05/2023 by LPA Quiroz.
During the course of the investigation, LPA Quiroz conducted interviews with interviewees consisting of staff and residents. LPA Quiroz also conducted documentation review but not limited to resident roster, staff roster, physician reports, identification forms and Infection Control Inservice Material and Inservice logs dated 4/14/2023 and 6/5/2023.
Regarding the allegation " Staff are not following infectious control plan,” the investigation revealed the following: Seven of eight interviewees consisting of residents and staff denied the allegation indicating staff are following infectious control plan as evidenced by conducting hand hygiene/washing, utilizing Protective Personal Equipment (PPE) for COVID-19 precautionary measures, cleaning and disinfecting re-usable medical equipment...CONTINUED ON NEXT LIC 9099-C PAGE...
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023
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 2
Control Number 22-AS-20230531092156
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: 10/17/2023
NARRATIVE
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CONTINUED...and handling blood and other potential infectious materials following all safety precautionary measures.
During the facility inspection visits conducted on 6/5/2023 and on today’s date, LPA Quiroz observed facility staff working at the facility to be wearing pertinent Personal Protective Equipment (PPE), conducting hand hygiene, cleaning and disinfecting with use of gloves in appropriate settings as evidence by observing staff utilizing gloves when disinfecting bathroom areas, transporting trash, serving meals and while washing dirty linen and resident’s clothing items in laundry area.
Therefore, based on the preponderance of evidence gathered through interviews, observations conducted by LPA Quiroz and documentation review, the allegations that the " Staff are not following infectious control plan” is deemed UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. This agency has investigated this complaint.
No deficiencies cited during today's visit.
An exit interview was conducted with (AD) Erin Rehbein and a copy of report was provided at exit.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 10/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2