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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 03/26/2025
Date Signed: 03/26/2025 12:48:56 PM

Unsubstantiated


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
03/20/2025 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250320123519
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: 110DATE:
03/26/2025
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:John Garcia - Facility Manager
Kathleen Tamondong - Assistant Administrator 		TIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff are mismanaging residents medication
Staff did not ensure resident was seen by their own physician
INVESTIGATION FINDINGS:
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On this Day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannoucned visit to conduct a complaint investigation.LPA was greeted and granted entry into the facility and explained the reason for the visit.

The Department received a complaint on 03/20/2025 and the initial 10 day visit was conducted on 03/26/2025. During the visit LPA Mendivil interviewed staff and residents. LPA Mendivil obtained copies of physician report, needs and services, preapprasial, admission agreement. Regarding the allegations staff are mismanging residents medication and staff did not ensure resident was seen by their own physician, the invesitgation revealed the following:

It was alleged the facility was mismanaging residents' medication. Per interviews with 6 out of 6 residents stated the facility provides their medications as prescribed. Per interviews with 4 out of 4 staff indicated they provide all resident medications as prescribed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
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-20250320123519
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: 03/26/2025
NARRATIVE
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4 out of 4 staff stated if the resident refuses the medication they will notate the refusal in the resident's chart. Interviews with staff indicated if a resident has a pattern of refusals they notify the resident's physician. Interviews also indicated staff would advise residents' of the side effects of refusals of certain medications. Staff stated they understand residents have the right to refuse medications and they honor that right.

6 out of 6 residents stated they are able to see a doctor of their choosing based on their own insurance. Facility manager stated they allow residents to choose their own physician based on their insurance. 4 out of 4 staff denied the allegation that facility is not allowing residents to see a physician of their own choosing.

Therefore based on the preponderance of evidence through interviews and records reviewed the allegations staff are mismanaging residents medication and staff did not ensure resident was seen by their own physician are determined to be UNSUBSTANTIATED, meaning 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.

No deficiencies cited at this time and an exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 03/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2