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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 04/20/2026
Date Signed: 04/20/2026 09:50:26 AM

Substantiated


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
01/23/2026 and conducted by Evaluator Garlli Tat
COMPLAINT CONTROL NUMBER: 22-AS-20260123164353
FACILITY NAME:PALMS RETIREMENT CENTERFACILITY NUMBER:
306006071
ADMINISTRATOR:BAHADORY, KHATERAFACILITY TYPE:
740
ADDRESS:312 N ROOSEVELT AVETELEPHONE:
(626) 353-4710
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY:144CENSUS: 106DATE:
04/20/2026
UNANNOUNCEDTIME BEGAN:
08:49 AM
MET WITH:Kathleen TamondongTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff are not addressing scabies outbreak.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Garlli Tat made an unannounced visit to the facility to deliver the findings on the above allegation. LPA met with the Assistant Administrator Kathleen Tamondong and explained the purpose of the visit.
During the investigation, LPA inspected the facility, interviewed staff and residents, and collected and reviewed documents including the medical records, progress notes, care plans, medication lists, physician’s reports, staff roster, and client roster.
The investigation revealed the following:

It was alleged that Staff are not addressing scabies outbreak.
Resident 1 (R1) moved into the facility on July 2, 2025 and moved out on January 11, 2026. On November 21, 2025, R1 was sent to the hospital due to a rash. It was confirmed that R1 was diagnosed with scabies at the hospital on November 21, 2025. R1 was treated with Permethrin ointment and discharged back to the facility the same day. Continued on LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Garlli Tat
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
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-20260123164353
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: 04/20/2026
NARRATIVE
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Permethrin is a medication used to treat scabies. The physician’s orders from the hospital dated November 21, 2025, stated that the discharge instructions were to wash off the Permethrin ointment in 8 to 14 hours and reapplied in 7 days. LPA reviewed R1’s Medication Administration Record (MAR) for the month of November to January 2026 which shows prescribed Permethrin medication was not noted in the MAR and was not given to the resident.

A review of incident report from the facility shows that there have been no reports of scabies in November 2025 received by our Department. Seven out of seven staff including the Administrator interviewed denied that there were scabies incident in the facility on November 2025. LPA made several attempts to contact R1's family member to interview but was unsuccessful.

Based on evidence gathered through interviews and document review, the preponderance of evidence has been met, therefore, the above allegation is found to be Substantiated. Violations are being cited per Title 22 of California Code of Regulations. See LIC 9099-D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with Assistant Administrator and a copy of this report and the LIC9099-D, along with a copy of the Appeal Rights were left at the facility.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Garlli Tat
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260123164353
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/20/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/30/2026
Section Cited
CCR
87211(a)(1)
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87211(a)(1) Reporting Requirements
(a) Each licensee shall furnish to the licensing agency [...]: (1) A written report shall be submitted to the licensing agency [...] of the occurrence of any of the events specified in (A) through (D) below. This report shall include the [...] nature of event; [...] findings,
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Licensee agrees to submit a written statement of understanding after reviewing the Titte 22 Regulations under 87211 Reporting Requirements. In addition, proof of training to all the staff will be submitted by POC due date on how the facility will ensure that scabies
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and treatment, if any; and disposition of the case. This requirement was not met as evidenced by: Based on record reviews and interviews, the facility failed to report the scabies incident of R1, which poses a potential health and safety risk to residents in care.
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incidents will be reported to CCLD.
Type B
04/30/2026
Section Cited
CCR
87464(f)(1)
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(f) Basic services shall at a minimum include: (1) Care and supervision as defined in[...] Health and Safety Code section 1569.2(c).[...] (c) "Care and supervision" means the facility assumes responsibility for[...]assistance of daily living [...] includes taking medications [...]. This requirement was not met as
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Licensee agrees to submit a written statement of understanding after reviewing the Titte 22 Regulations under Basic Services 87464. In addition, proof of training to all the staff will be submitted by the POC due date on how the facility will assist with medication administration and personal care regarding
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evidenced by: Based on record review and interviews, the facility failed to ensure R1's prescribed medication for scabies was given since it was noted in the facility MAR. Facility also denied having a scabies incident for R1. This poses a potential health and safety risk to residents in care if facility is unaware of the resident scabies conditions.
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any scabies incidents.
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: Sheila Santos
LICENSING EVALUATOR NAME: Garlli Tat
LICENSING EVALUATOR SIGNATURE:

DATE: 04/20/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/20/2026
LIC9099 (FAS) - (06/04)
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