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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
306006071
Report Date:
10/18/2023
Date Signed:
10/18/2023 04:36:02 PM
Document Has Been Signed on
10/18/2023 04:36 PM
- It Cannot Be Edited
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
FACILITY EVALUATION REPORT
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
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:
113
DATE:
10/18/2023
TYPE OF VISIT:
Collateral
UNANNOUNCED
TIME BEGAN:
02:19 PM
MET WITH:
Administrator Erin Rehbein
TIME COMPLETED:
04:50 PM
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On this day Licensing Program Analyst (LPA) Jenifer Tirre made an unannounced visit for the purpose of conducting a collateral visit in regards to an open complaint investigation unrelated to current licensee.
LPA met with Administrator Erin Rehbein and explained reason for the visit
On this day LPA conducted interviews related to complaint control number:
22-AS-20200925103558
During visit LPA conducted additional interviews and gathered records related with the following open complaints for Palms Retirement Center:
22-AS-20231009110307
22-AS-20230829083600
22-AS-20230802135409
22-AS-20230727154102
Exit interview conducted with Administrator and copy of report was provided to facility.
SUPERVISORS NAME
:
Luz Adams
LICENSING EVALUATOR NAME
:
Jenifer Tirre
LICENSING EVALUATOR SIGNATURE
:
DATE:
10/18/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/18/2023
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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