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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006071
Report Date: 07/15/2025
Date Signed: 07/24/2025 11:37:47 AM

Unfounded


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
07/01/2025 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20250701132137
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: 107DATE:
07/15/2025
UNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Khatera BahadoryTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility failed to issue proper notification for rate increase
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On July 15, 2025, Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced complaint investigation at the facility. Upon arrival, LPA Haddadin was greeted by Khatera Bahadory AD, who granted entry and was advised of the purpose of the visit. During the investigation, the analyst toured the premises, residents and staff and reviewed all pertinent facility records concerning the allegation The allegation under review stated that the facility failed to issue proper notification for a rate increase. The investigation revealed that on March 31, 2025, the facility provided R1 with a proper 60-day written notice of a rate increase, scheduled to take effect on June 1, 2025. During an interview with the LPA, R1 confirmed receipt of the notice. Based on observations, interviews, and the information gathered during the investigation, the preponderance of the evidence standard has not been met. Therefore, the allegation that the facility issued an unlawful eviction is deemed UNFOUNDED. An unfounded allegation means the evidence indicates the charge is false, could not have happened, or is without a reasonable basis. Accordingly, the department has dismissed the complaint. An exit interview was conducted, and a copy of this report was provided to the Administrator.
*****AMENDED*****
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
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
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
07/01/2025 and conducted by Evaluator Samer Haddadin
COMPLAINT CONTROL NUMBER: 22-AS-20250701132137

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: 107DATE:
07/15/2025
UNANNOUNCEDTIME BEGAN:
08:08 AM
MET WITH:Khatera BahadoryTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident issued an unlawful eviction
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On July 24, 2025, at approximately 11:05 AM, Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced complaint investigation at the facility. Upon arrival, LPA Haddadin was greeted by Administrator (AD) Khatera Bahadory, who granted entry and was advised of the visit's purpose. During the inspection, the LPA toured the premises, interviewed relevant parties, and reviewed facility records, including those pertaining to Resident R1. The allegation under investigation was that the facility issued an unlawful eviction notice to R1. four out four residents and staff interviewed denied allegations. Also,the investigation revealed that on March 31, 2025, the facility provided R1 with a proper 60-day written notice of a rate increase, scheduled to take effect on June 1, 2025. During an interview with the LPA, R1 confirmed receipt of the notice but stated they had confused the rate increase notification with an eviction notice. Furthermore, a review of facility records indicated that R1 had failed to pay rent for March, April, and May of 2025, which was prior to the effective date of the rate increase. Due to this continued nonpayment, the facility issued a 30-day eviction notice to R1 on July 11, 2025. The LPA reviewed this eviction notice and verified that its issuance complied with Title 22 of the California Code of Regulations. Based on observations, interviews, and the information gathered during the investigation, the preponderance of the evidence standard has not been met. Therefore, the allegation that the facility issued an unlawful eviction is deemed UNFOUNDED. An unfounded allegation means the evidence indicates the charge is false, could not have happened, or is without a reasonable basis. Accordingly, the department has dismissed the complaint. An exit interview was conducted, and a copy of this report was provided to the Administrator.
*****AMENDED*****

Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
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 2