306006071-7-15-2026-22-AS-APAO-DWE4A3-20260727185515

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 07/15/2026
Date Signed: 07/15/2026 04:19:08 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
08/29/2023 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230829083600

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: 110	DATE:	07/15/2026
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Administrator Didimay Dimacali		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility is not isolating COVID positive residents.
Facility does not have an adequate amount of PPE.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jenifer Tirre, met with Administrator Didimay Dimacali for the purpose of
delivering findings for the above allegations. The investigation consisted of observations, records reviewed and interviews conducted. On August 29, 2023, the department received allegations that Facility is not isolating COVID positive residents and Facility does not have an adequate amount of PPE. The investigation was completed by the department and revealed the following:

Regarding Facility is not isolating COVID positive residents
Per observations residents were relaxing in common areas and spread apart throughout common areas. Residents who tested positive had signs posted on room doors notifying visitors. Per record review, Department provided a Covid log of residents who were positive. Covid log showed several sets of roommates who were isolating together as well as individual residents in private rooms. Log provided onset of positives as well as symptoms. Per facility Infection Control Plan dated May 25, 2022, stated facility to contact Infection Preventionist, remind residents of proper hand hygiene, and additional cleaning and disinfection activities to be completed by staff in common areas. CONTINUED ON 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

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-20230829083600

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: 07/15/2026

NARRATIVE

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Plan also states that separation and quarantine would be provided in cases needed. Per Staff interviews, staff stated residents were being monitored and given face masks. Staff stated they encouraged residents to stay isolated in rooms and that meals would be delivered to rooms. Staff mentioned that if positive residents needed to go out of facility for appointments, residents were reminded to wear masks when in public.

Regarding Facility does not have an adequate amount of PPE:
Per observations, the Department observed facility has supply closet with Personal Protective Equipment (PPE) such as boxes upon boxes of Vinyl Gloves, Face Masks, and N-95 Face masks. Facility has extra additional sheets and bedding available. Department also observed hand sanitizing stations placed through out facility hallways and in common areas available to residents, staff and visitors. Per record review Department obtained copies of PPE invoices and packing slips for purchased PPE supply. Per interviews, Staff stated that PPE Supplies were available and that masks were provided to residents during the time of initial complaint.

Based on information provided from investigation, the allegations Facility is not isolating COVID positive residents and Facility does not have an adequate amount of PPE was deemed UNSUBSTANTIATED meaning that although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur as reported.

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

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2026

LIC9099 (FAS) - (06/04)

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