306006071-4-28-2026-22-AS-SSAS-DTN28J-20260430171026

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 04/28/2026
Date Signed: 04/28/2026 04:52:54 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
07/13/2022 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220713090933

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: 107	DATE:	04/28/2026
		UNANNOUNCED	TIME BEGAN:	04:23 PM
MET WITH:	Kathleen Tamondong		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff mismanaged resident toileting supplies
Resident was left in soiled bedding for extended amount of time
Staff handled resident roughly

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit to deliver findings. LPA Tirre was greeted and granted entry into the facility by staff and explained reason for visit. During course of investigation, LPA conducted interviews, reviewed records, toured facility and made visual observations. Department requested pertinent documentation such as Physician’s Report, Admission Agreement, Appraisal, Needs and Service plan, face sheet, staff roster and Resident Roster. The investigation conducted revealed the following:

Staff mismanaged resident toileting supplies
Per staff interviews, five of five staff stated that Resident 1 (R1) was on incontinent supplies and received supply from DME (Durable Medical Equipment) Provider monthly. Staff stated that R1’s supplies were covered through insurance. Staff stated that R1 likes to drink a lot of liquids and goes through incontinent supplies but has never ran out of supplies. Interview with witness stated they do not know anything regarding incontinence supplies. Interview with R1 stated that they ran out of supplies and were informed by staff to pee on bed.
cont 9099c

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

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-20220713090933

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: 04/28/2026

NARRATIVE

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Per observation, during investigation visits, LPA observed resident had a supply of diapers and under pads piled high on side of television next to wall across from R1’s bed. LPA observed incontinent supplies throughout resident’s room.

Resident was left in soiled bedding for extended amount of time

Per staff interviews, five of five staff stated that they were not made aware of R1 being left in soiled bedding for period of time. Staff interviews stated that R1 did need assistance with toileting and would be changed 3 to 4 times a day as well as checked on every two hours.

Per witness interview, witness is aware of R1 needing assistance but does not know how often it is given at facility. Per R1 interview, R1 stated that on one particular occasion a staff member made them pee inside diaper and was left in soiled diaper for two days.

Per observations LPA observed R1 to be comfortable during visits and R1 stated that they were not having the soiled issues as before.

Per records reviewed R1’s physicians reports dated 4/23/22, 6/21/24 & 3/5/26 stated that R1 needs assistance with bathing, dressing and toileting due to their physical condition. Needs and Service Plan dated 6/20/25 states that R1 is total assist with bathing, grooming, dressing and toileting.

Staff handled Resident roughly

Per interviews, five of five staff stated that R1 never mentioned to them about being handled roughly by staff at facility. One staff member stated they were aware that R1 always requested about being handled “gently” while staff were providing care.

Interview with R1 stated that a Care giver whose first name was provided shoved R1 against bed roughly and was rude. Interview with witness stated that R1 denied the allegation regarding staff, stating that R1 claims they were never pushed by a staff member, there was no abuse happening and that they felt safe at facility.

Per observations, staff member whom R1 mentioned was not available for interview on 8/15/22 and was informed Staff member no longer works at facility and left back in 2022. LPA did not observe staff member on roster on 3/25/26.

Per information gathered from investigation, the allegations Staff mismanaged toileting supplies, Resident was left in soiled bedding for extending amount of time and staff handled resident roughly were deemed UNSUBSTANTIATED meaning that although the allegations may have happened or are valid, there is no preponderance of evidence to prove that the alleged violations occurred as reported.

An exit interview was conducted with Administrator Kathleen Tamondong, copy of report was discussed and provided.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2026

LIC9099 (FAS) - (06/04)

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