306006071-6-22-2026-22-AS-SSAS-DVTU9T-20260709152341

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 06/22/2026
Date Signed: 06/22/2026 12:41:22 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
06/17/2026 and conducted by Evaluator Brandon Lopez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260617130520

FACILITY NAME:	PALMS RETIREMENT CENTER		FACILITY NUMBER:	306006071
ADMINISTRATOR:	BAHADORY, KHATERA		FACILITY TYPE:	740
ADDRESS:	312 N ROOSEVELT AVE		TELEPHONE:	(626) 353-4710
CITY:	FULLERTON	STATE: CA	ZIP CODE:	92832
CAPACITY:	144	CENSUS: 109	DATE:	06/22/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Administrator Maria Dimacali		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Facility does not have an adequate plan to address resident's medication needs
Staff did not provide requested document to resident's doctor

INVESTIGATION FINDINGS:

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On June 22, 2026, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to initiate the investigation into the allegations listed above. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. Administrator Maria Dimacali was notified via telephone and later arrived to assist with the inspection.

During the course of the investigation, LPA interviewed residents, interviewed staff, reviewed and obtained pertinent documents for this complaint such as resident medication records. Regarding the allegation, facility does not have an adequate plan to address resident's medication needs, the following has been concluded: It was alleged that the facility does not have an adequate plan to address Resident #1 (R1) medication needs. LPA conducted a file review for R1 including R1's active medication orders. LPA observed that R1 receives assistance from the facility with their medications and R1's medications include both routine and as needed medications. LPA reviewed the facility's personnel report and observed that the facility currently has seven staff employed who are able to assist resident's with their medication needs.
CONTINUED ON LIC9099-C

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2026

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-20260617130520

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: 06/22/2026

NARRATIVE

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Based on a review of the personnel report, it appears that there is sufficient staff coverage to assist R1, and other residents, with their medication needs during all times of the day. LPA conducted an interview with R1. R1 denied any issues with his medication needs and denied any issues with requesting his as needed medications from staff. LPA conducted an additional five resident interviews. The five residents interviewed stated that they all receive assistance with their medications from the facility and they also denied any issues with their medication needs. LPA conducted four staff interviews. Four out of the four staff interviewed denied the allegation and reported that there is at least one staff on duty at all times during each day to assist residents with their medication needs.

Regarding the allegation, staff did not provide requested document to resident's doctor, the following has been concluded: It was alleged that staff did not provide requested document to R1's doctor. LPA attempted to conduct an interview with R1's doctor, Witness #1 (W1). However, LPA was unable to make contact with W1 for an interview after multiple attempts. LPA conducted an interview with R1. R1 stated that he did not recall if staff provided him with a copy of his medication list to give to his doctor, W1. LPA conducted four staff interviews. Two staff were unable to provide any useful information for this allegation. However, the other two staff denied the allegation and stated that staff did provide R1's doctor with the document that they requested.

Based on the evidence gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the two allegations above are deemed UNSUBSTANTIATED. An exit interview was conducted with Administrator Maria Dimacali and a copy of the report was provided at time of visit.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Brandon Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 06/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2026

LIC9099 (FAS) - (06/04)

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