306006071-2-4-2026-22-AS-APAO-DR78KX-20260210213553

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 02/04/2026
Date Signed: 02/04/2026 12:55:27 PM

Unsubstantiated

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
01/30/2026 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260130160632

FACILITY NAME:	PALMS RETIREMENT CENTER		FACILITY NUMBER:	306006071
ADMINISTRATOR:	BAHADORY, KHATERA		FACILITY TYPE:	740
ADDRESS:	312 N ROOSEVELT AVE		TELEPHONE:	(626) 353-4710
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92832
CAPACITY:	144	CENSUS: 104	DATE:	02/04/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Khatera Bahadory- Administrator		TIME COMPLETED:	01:10 PM

ALLEGATION(S):

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Staff did not keep facility free of insects.

INVESTIGATION FINDINGS:

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On February 4, 2026, Licensing Program Analyst (LPA) Jessica Cho arrived at the facility unannounced for the purpose of initiating the complaint investigation into the above allegation. LPA was greeted by the receptionist and was introduced to Wellness Director (WD) Adriana Delgado. Administrator (Admin) arrived approximately 10am and remained at the faciltity to assist with obtaining records. During the course of the investigation, LPA toured the facility guided by WD Delgado and inspected the kitchen and ten units consisting of three memory care units on the first floor, two assisted living units on the 1st floor, and five assisted living units on the second floor. LPA interviewed ten residents, four staff, and obtained copies of the following records for review: Resident Roster, Personnel Report Summary, Face Sheets, Physician's Reports, and Pest Control Service Reports.

The investigation is as follows: Regarding the allegaiton, Staff did not keep facility free of insects, it is alleged that a cockroach was observed on January 30, 2026. Based on the inspection of ten units, no cockroaches were observed in the units, bathrooms, and furniture.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026

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-20260130160632

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: 02/04/2026

NARRATIVE

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LPA did not observe any cockroaches in the hallway. LPA observed the housekeeping staff on shift and cleaning each unit and common areas. Two out of ten residents confirmed seeing cockroaches in the hallways and in their rooms while four out of four staff denied observing and receiving reports of cockroaches from residents. Four out of four staff confirmed that the facility receives monthly pest control services or as needed. In review of the pest control service reports, LPA confirmed the pest control services the facility on a monthly basis. The service reports dated November 25, 2025, December 29, 2025, and January 30, 2026, documents no signs of cockroach activity per the inspections or observed by staff. The investigation revealed that although two of ten residents confirmed observing cockroaches, there were no signs of activity in the ten units, hallway, and kitchen per LPA's inspection which was also confirmed on the service reports. It is determined that facility is actively addressing the issue by implementing proactive measures and utilizing professional pest control services.

Therefore, due to conflicting information, the allegation is deemed UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted with Administrator Khatera Bahadory, and a copy of this report was provided at exit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 02/04/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2026

LIC9099 (FAS) - (06/04)

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