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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 336403366
Report Date: 09/19/2025
Date Signed: 09/19/2025 03:22:24 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/18/2025 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250918170221
FACILITY NAME:PALM COURT ASSISTED LIVINGFACILITY NUMBER:
336403366
ADMINISTRATOR:AURELIEN FRUITFACILITY TYPE:
740
ADDRESS:201 S. SUNRISE WAYTELEPHONE:
(760) 327-8351
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:130CENSUS: 130DATE:
09/19/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Carminia Meza, Director of NursingTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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9
Resident was issued an unlawful eviction notice.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to initiate an investigation for the above allegation. LPA met with Carminia Meza, Director of Nursing, and informed them of the purpose the LPA's visit.

On 09-18-2025, Community Care Licensing (The Department) received a complaint report with the following allegation. It was alleged resident was issued an unlawful eviction notice. LPA conducted review of records and staff interview. LPA determined that the eviction notice was issued to the responsible person of Resident #1 (R1) on 09-17-2025 without an approval from The Department. A citation regarding this same deficiency was issued by the LPA during the LPA's case management visit on 09-18-2025. This allegation is Substantiated. A finding that the complaint is SUBSTANTIATED means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where a copy of this report was reviewed and provided.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/18/2025 and conducted by Evaluator Seo Jeon
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20250918170221

FACILITY NAME:PALM COURT ASSISTED LIVINGFACILITY NUMBER:
336403366
ADMINISTRATOR:AURELIEN FRUITFACILITY TYPE:
740
ADDRESS:201 S. SUNRISE WAYTELEPHONE:
(760) 327-8351
CITY:PALM SPRINGSSTATE: CAZIP CODE:
92262
CAPACITY:130CENSUS: 130DATE:
09/19/2025
UNANNOUNCEDTIME BEGAN:
01:50 PM
MET WITH:Carminia Meza, Director of NursingTIME COMPLETED:
03:40 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not report medication issues to authorized representative
Authorized Representative requested documentation and staff did not provide
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Seo Jeon conducted an unannounced visit to the facility to initiate an investigation for the above allegations. LPA met with Carminia Meza, Director of Nursing, and informed them of the purpose of the LPA's visit.

On 09-18-2025, Community Care Licensing (The Department) received a complaint report with the following allegations. It was alleged that staff did not report medication issues to authorized representatives. LPA conducted interview with Meza who stated Resident #1's (R1) medication issues including medication refusal were reported to R1's responsible person. LPA's records review corroborated Meza's statement.

It was also alleged that authorized representative requested documents and staff did not provide. LPA conducted interview with Meza who stated R1's care plan has been sent to R1's responsible person, and its acknowledgement was signed by R1's responsible person. LPA's records review corroborated Meza's statement. Continued on LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 18-AS-20250918170221
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PALM COURT ASSISTED LIVING
FACILITY NUMBER: 336403366
VISIT DATE: 09/19/2025
NARRATIVE
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Based on record reviews and interviews, above allegations are Unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted where a copy of this report was provided.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Seo Jeon
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3