306006071-3-25-2026-22-AS-APAO-DTU4ZE-20260506193235

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 03/25/2026
Date Signed: 03/25/2026 04:25:01 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
11/02/2022 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20221102163155

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: 105	DATE:	03/25/2026
		UNANNOUNCED	TIME BEGAN:	07:10 AM
MET WITH:	Administrator Khatera Bahadory		TIME COMPLETED:	12:59 PM

ALLEGATION(S):

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Staff made inappropriate comments towards resident.
Facility not providing resident with requested documents.
Staff not ensuring resident is bathed.
Facility failed to administer medications as prescribed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit to deliver complaint findings LPA Tirre was greeted and granted entry into the facility by staff and explained reason for visit with Administrator Khatera Bahadory

During the course of investigation, LPA reviewed records and conducted interviews. Department requested pertinent documentation such as Physician’s Reports, Medication Administration record, Medication logs, Appraisals and Admission Agreement. The investigation conducted revealed the following:

On November 2, 2022 the department received a complaint alleging Staff made inappropriate comments towards resident, Facility not providing resident with requested documents, Staff not ensuring resident is bathed and Facility failed to administer medications as prescribed.

CONTINUED ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

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-20221102163155

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: 03/25/2026

NARRATIVE

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Regarding Allegation Staff made inappropriate comments towards resident, Interview with Resident 1 (R1) stated that a staff member who they preferred not to name, made the following inappropriate comment after a witnessed fall “ you’re old and don’t need your knee’s. You are going to die”. R1 stated staff member made them feel shun for the incident occurring. Interviews with staff revealed that 5 of 6 staff members were not aware of inappropriate comments made and stated that R1 did not express concerns regarding staff.

Regarding Allegation Facility not providing resident with requested documents, Interview with R1 stated that they needed personal records for upcoming doctors appointment, however when asked what records they needed and if they received such records, R1 could not recall the records requested and whether they received documents. Interview with Staff 1 (S1), revealed that R1 requested a copy of their Admission Agreement and S1 stated they provided document to R1.

Regarding Allegation Staff not ensuring resident is bathed, based on documents received, R1’s Physician reports dated 10/28/22 under capacity for self care stated that R1 needs assistance with bathing. R1’s Functional capability assessment dated 9/30/22 also states R1 needs help with bathing and showering. No shower logs provided for R1. Interview with R1 revealed that they often wait to be showered. Interviews with staff members revealed that 3 of 6 staff stated that R1 was on a showering schedule. Interviews with staff revealed that 3 of 6 staff stated R1 had showers as needed 3 to 7 days a week.

Regarding Allegation Facility failed to administer medications as prescribed, Record review revealed that R1 was on two medications for pain management (Hydrocodone Acetaminophen and Tramadol HCI) both meds prescribed as take one pill every six hours as needed for pain. Resident also on Trazodone for Insomnia. Medication logs from 11/5/22-11/7/22 show R1 received Pain medication Tramadol 6x for pain. Facility nurse notes state on 11/11/22 Doctors office contacted facility that they were not going to refill Norco pain med due to resident being referred to pain management doctor & resident was informed. Interview with R1 stated that they were not receiving their Norco (Hydrocodone Acetaminophen) medication and instead was given “Trazodone”. Interview with Staff 2 revealed that R1 is given medications as prescribed. Interview with Staff 1 stated that R1 always wanted PRN pain meds immediately after making request and wanted additional dosage immediately after an hour.

Based on information provided in investigation, the preponderance of evidence has not been met, deeming the allegations Staff made inappropriate comments towards resident, Facility not providing resident with requested documents, Staff not ensuring resident is bathed and Facility failed to administer medications as prescribed to be Unsubstantiated meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred as reported.

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

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 03/25/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/25/2026

LIC9099 (FAS) - (06/04)

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