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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 11:57:00 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
05/30/2023 and conducted by Evaluator Rosie Quiroz
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20230530102018
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:
09:07 AM
MET WITH:Erin Rehbein, AdministratorTIME COMPLETED:
10:46 AM
ALLEGATION(S):
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-Staff did not provide resident with facility rules and regulations in a timely manner
-Facility has roaches
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 receptionist 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, Admission Agreements, Facility House Rules, Infection control Inservice records and Pest Control Invoices dated 3/09/2023, 3/23/2023, 4/20/2023 and 5/18/2023.
Regarding the allegation " Staff did not provide resident with facility rules and regulations in a timely manner," the investigation revealed the following: Interview indicating “I did receive it, I had misplaced it, but I found it.” During documentation review of four of four resident's files, LPA Quiroz observed copy of facility house rules and Admission Agreements in four of four resident's files. 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-20230530102018
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...Four of four residents interviewed indicated receiving a copy of facility rules and regulations in a timely manner.
Regarding the allegation "Facility has roaches," the investigation revealed the following: Seven of eight interviewees consisting of staff and residents denied the allegation indicating not observing any roaches in their bedroom and bathroom areas or through out the facility. Documentation review of Pest Control Invoices dated 3/09/2023, 3/23/2023, 4/20/2023 and 5/18/2023 indicated no pest found during the routinely monthly inspection maintenance visits.
Therefore based on the preponderance of evidence gathered through interviews, observations conducted by LPA Quiroz and documentation review, the allegations that the "Staff did not provide resident with facility rules and regulations in a timely manner,” and “Facility has roaches,” are deemed UNFOUNDED, meaning that the allegations were false, could not have happened and/or are without a reasonable basis. This agency has investigated this complaint.

No deficiencies cited during today's visit.

An exit interview was conducted with (AD) 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