306006071-6-3-2026-22-AS-APAO-DVU76Z-20260709212359

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 06/03/2026
Date Signed: 06/03/2026 01:16:41 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
07/31/2024 and conducted by Evaluator Cassandra Mikkelson

COMPLAINT CONTROL NUMBER: 22-AS-20240731154451

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:	DATE:	06/03/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:			TIME COMPLETED:	01:35 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are disclosing a resident's personal information
Staff are mishandling a resident's medications
Staff are interfering with a resident's medical decisions
Staff are not affording a resident privacy
Staff are stealing the resident's personal belongings
Staff are not following a licensed physician's orders
Staff are threatening a resident
Staff are unlawfully evicting a resident
Staff are falsifying and misplacing records of a resident
Staff do not seek timely health and medical attention for a resident
Staff are overcharging a resident
Staff are not properly reporting incidents involving a resident
Staff do not address a resident's change in medical condition
Staff are not providing adequate food service to a resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 06/03/2026, Licensing Program Analyst (LPA) contacted the licensee via email to deliver final findings regarding a complaint that was received on 07/31/2024.

**Continued on 9099-C page

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026

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-20240731154451

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: 06/03/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Staff are disclosing a resident's personal information

Based on the information obtained during the course of the investigation, the Department is unable to determine the validity of the allegation listed above. Therefore, the allegation listed is unsubstantiated.

Staff are mishandling a resident's medications

Staff are interfering with a resident's medical decisions

Staff are not affording a resident privacy

Staff are stealing the resident's personal belongings

Staff are not following a licensed physician's orders

Staff are threatening a resident

Staff are unlawfully evicting a resident

**Continued on 9099-C2 page

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 22-AS-20240731154451

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: 06/03/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Staff are falsifying and misplacing records of a resident

Staff do not seek timely health and medical attention for a resident

Staff are overcharging a resident

Staff are not properly reporting incidents involving a resident

Staff do not address a resident's change in medical condition

Staff are not providing adequate food service to a resident

A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Licensee was advised a copy of this report will be sent via certified mail. Two copies of this report will be sent. The Licensee is to sign and return a copy to the Orange County Regional office.

SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Cassandra Mikkelson
LICENSING EVALUATOR SIGNATURE:	DATE: 06/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3