306006071-7-15-2026-22-AS-APAO-DWE5ST-20260727201316

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 07/15/2026
Date Signed: 07/15/2026 04:03:43 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
07/27/2023 and conducted by Evaluator Jenifer Tirre

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230727154102

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:	07:13 AM
MET WITH:	Administrator Didimay Dimacali		TIME COMPLETED:	12:59 PM

ALLEGATION(S):

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Resident sustained rash while in care
Facility not safe guarding residents clothes

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 July 27, 2023, the department received allegations that Facility Resident sustained rash while in care and Facility not safe guarding residents clothes. The investigation was completed by the department and revealed the following:

Regarding Facility resident sustained a rash while in care, It was reported to Department that resident had a rash that spread on Residents body. Per observations, resident was observed with redness on arms. Department observed (R1) was gently scratching at arms which were lightly wrapped up with a sleeve so that R1 would not pick at skin. Per records reviewed R1 Physician’s report dated February 28, 2023, stated R1 did not have a history of skin breakdown. Shower Skin Assessment dated March 3, 2023, stated that R1 was noted to have red areas and unusual marks. Assessment noted that R1 had three red spots on right lower arm and two marks on knees. 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-20230727154102

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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Facility Charting notes dated 7/25/2023 to 7/27/2023 state that R1’s family would have to work on dermatology appointments due to dermatology not being covered under Hospice care. Notes from 7/27/2023, states Hospice requested for inspection of R1’s room to which Facility conducted an inspection to which no signs of bed bugs or scabies were found in surrounding furniture inside room. Charting notes also state that R1’s Doctor will be contacted regarding medication for resident’s itching. On 7/27/2023, notes state that R1’s laundry soap was changed out due to possibility of causing skin irritation. Per interviews conducted, Witness interviews stated that R1 had a rash on arms that caused itching. Witness interviews stated that R1’s was believed to have a residual rash of dermatitis. Per staff interviews, staff stated that once notified of rash, facility had maintenance come out and perform inspection for bed bugs and scabies to which none were found. Staff interviews stated that facility switched out mattress, cleaned sheets as well as switched laundry detergents. Staff stated that they were looking to what could be root cause of rash and stated that R1 was the only resident who had rash, no other residents had a rash at time of initial complaint.

Regarding Facility not safe guarding residents clothes, Per observations, LPA toured residents room where clothes and personal belongings were observed inside drawers. Per record review, R1 had a personal property and valuables list where 14 items were noted from clothing, shoes, hats, watch and glasses. Per interviews with staff, staff state that upon admission to facility Residents are to mark clothing with a marker with their name to differentiate residents clothes. Staff also mentioned that after clothing is washed staff take clothing to residents room once completed. Staff mentioned that in Memory Care section, that staff are monitoring residents and stated that on rare occasions they will see residents wander into other residents room to which staff will redirect. Staff stated they aren’t aware of clothing being stolen or other residents wearing other residents clothing.

Based on information provided from investigation, the allegations Facility resident sustained a rash while in care and facility not safe guarding residents clothing 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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