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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006071
Report Date: 02/09/2022
Date Signed: 02/09/2022 10:58:52 AM

Document Has Been Signed on 02/09/2022 10:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 CENTERFACILITY NUMBER:
306006071
ADMINISTRATOR:BARRIENTOS, ELEANORFACILITY TYPE:
740
ADDRESS:312 N. ROOSEVELT AVETELEPHONE:
(626) 353-4710
CITY:FULLERTONSTATE: CAZIP CODE:
92832
CAPACITY: 144CENSUS: 110DATE:
02/09/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Sona Bhatia and Katherine TrevinoTIME COMPLETED:
10:00 AM
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Licensing Program Analysts (LPA's) Kimberly Lyman and Claudia Gutierrez made an announced pre-licensing visit to follow up on corrections identified during visit on 01/10/2022. LPA's identified themselves and discussed the purpose of the visit with Licensee Sona Bhatia and Assistant Administrator's Katherine Trevino and Nelson Ormeyo. An initial application to operate a Residential Facility Care for the Elderly was submitted to CCL on 12/3/2021. There are 110 residents in care during today's visit. LPAs observed facility is following covid precaution guidelines.

At 9:15 AM, LPAs toured the facility and observed the following:
  • Water temperature measured between 105 and 108 degrees F. One room tested at 124 degrees F. Documented facility temp from the morning was 117.
  • Bath tubs in rooms 113, 115, 122, and 210 have been cleaned.
  • Sink has been repaired in room 127.
  • Sink in room 122 is free flowing.
  • Sink 113 has been repaired.
  • Bathroom door in room 210 has been repaired.
  • Grab bar and holes in the wall in bathroom 128 has been repaired.
  • Facility has posted the "Let Us No" poster in regulation size.



All noted items from visit on 01/10/2022 have been addressed.
The facility is ready to be licensed.


Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 02/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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