PALMCREST GRAND RESIDENCE

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a) Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidence by: Based on interviews and a review of records the laundry machines are in disrepair.

Official plan of correction

The licensee will fix the dryers and email proof of correction to Elvira.Gonzalez@dss.ca.gov

Deadline recorded: Jul 15, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(5)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself..... This requirement was not met as evidenced by:Based on interviews and record review the licensee did not have a physician’s order for Postural Supports and records revealed that on 9/29/2025 S1 did strap R1 to their wheelchair which resulted in injuries to R1 which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

The licensee has agreed to provide training to all staff members on the cited regulation and personal rights of residents in care. Proof of training was provided at the time of visit on 04/9/2026 during visit.

Deadline recorded: Apr 10, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87608(a)(5)

Regulation authority

CCR

What the official deficiency says

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself..... This requirement was not met as evidenced by:Based on interviews and record review the licensee did not have a physician’s order for Postural Supports and records revealed that S1 did strap R1 to their wheelchair which resulted in injuries to R1. This poses a potential health and safety risk to residents in care.

Official plan of correction

The licensee has agreed to provide training to all staff members on the cited regulation and personal rights of residents in care. Proof of training was provided at the time of visit on 11/11/2025 during visit.

Deadline recorded: Apr 9, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs... This requirement was not met as evidence by: Based on interviews and record review, the licensee failed to ensure that the facility did not complete (R#1)’s Needs and Services Plan each time they return from the hospital and there was not written documentation on the treatment plan changes after each incident. This poses a potential health and safety risk to residents in care.

Official plan of correction

The licensee will adhere to Title 22 regulations at all times. As a plan of correction, the facility will follow a new system that will allow facility staff record chek-ins of the residents. A proof of this correction will be sent to LPA Iniguez via email.

Deadline recorded: Feb 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(2)

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2)To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This requirement was not met as evidence by: Based on interviews and record review, the licensee failed to ensure that (R#1) was provided with the necessary care and services to prevent them from falling a few times. This poses a potential health and safety risk to residents in care.

Official plan of correction

The licensee will adhere to Title 22 regulations at all times. As a plan of correction, the facility will follow a new system that will allow facility staff record chek-ins of the residents. A proof of this correction will be sent to LPA Iniguez via email.

Deadline recorded: Feb 23, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87355(a)

Regulation authority

CCR

What the official deficiency says

87355 Criminal Record Clearance (a) The Department...all individuals specified in Health and Safety Code section 1569.17 and shall...deny... employment...or presence in the facility, based upon the results of such review. This has not been met as evidenced by: The facility has allowed one (1), uncleared, staff member to be employed at the facility.

Official plan of correction

Licensee (S1) has agreed that prior to returning to work at this care facility, the uncleared staff will have conducted a fingerprint clearance through Care Provider Management Bureau (CPMB) on, or before, the POC due date as 04/15/25. S1 will inform LPA of fingerprint findings at Mario.Leon@DSS.CA.GOV

Deadline recorded: Apr 15, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement is not met as evidenced by: Based on interviews and records review, the licensee did not comply with the section cited above as resident R1 prescribed medication was missed on 12/30/24-1/6/2025 which poses/posed a potential health, safety, or personal rights risk to persons in care.

Official plan of correction

Licensee will ensure compliance by developing a plan to prevent medication is missed due to resident changing doctor or insurances without letting facility know. Plan to be emailed to LPA by due date Deborah.Lee@dss.ca.gov.

Deadline recorded: Jan 29, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident: The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning... appropriate assistance is provided when such observation reveals unmet needs. When changes such as... deterioration... a physical health condition is observed, resident's responsible person...the licensee shall ensure that such changes...brought to the attention of the resident's physician... This requirement is not met as evidenced by: Facility staff had knowledge of (R1’s) health condition with UTI associated with severe abdominal pains, and failed to seek medical attention in a timely manner. This violation poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator agreed to comply and review Title 22 Regulation, Section “Observation of the Resident” and implement a plan detailing how Licensee/Administrator will ensure all residents are regularly observed for changes. The plan is due by POC date to LPA Dabuet via email: ernand.dabuet@dss.ca.gov

Deadline recorded: Sep 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(B)(D)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department...(B) Any serious injury... occurring while the resident is under facility supervision. (D) Any incident which threatens the welfare, safety or health of any resident... This requirement is not met as evidenced by: Based on record reviews and interviews, the licensee did not comply with the section cited above. The facility failed to submit written report associated with incident resident #1 and #2. The facility did not have proof of certified confirmations LIC 624 was faxed to CCL. This violation poses a potential health, safety or personal rights risk to persons in care.

Official plan of correction

Licensee/Administrator will review Title 22 Sec. 87211 and agreed to provide training to staff pertaining to CCL Reporting Requirements. Licensee will provide to LPA a sign-in sheet with staff signatures as proof that staff attended training by the POC date via email: ernand.dabuet@dss.ca.gov

Deadline recorded: Sep 13, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.1

Regulation authority

CCR

What the official deficiency says

87468.1 Personal Rights...in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of... personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This has not been met as evidenced by: Licensee did not provide R1 with dignity in their personal relationships with staff; as through interviews, S1 has been named and confirmed through six (6) out of eleven (11) total interviews

Official plan of correction

Administrator (S2) and LPA have agreed that the licensee will make arrangements to conduct further training(s) with S1. Licensee will provide adequate further training with S1, via email, to LPA at Mario.Leon@dss.ca.gov

Deadline recorded: Apr 30, 2024. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87463(c)

Regulation authority

CCR

What the official deficiency says

Reappraisals. The licensee shall arrange a meeting with the resident, the resident’s representative, if any, appropriate facility staff, and … if any, when there is significant change in the resident’s condition, …first, as specified in Section 87467, Resident Participation in Decision Making. This requirement was not met as evidenced by: Based on interviews and record reviews the licensee failed to ensure that R1 was reappraised following a change in their medical condition after hospitalization, which posed an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

The administrator agreed to create a plan of correction to ensure that reappraisals are conducted when significant change in the resident’s condition are observed. Proof of corrections will be submitted prior to POC due date, via email, to mario.leon@dss.ca.gov

Deadline recorded: Mar 1, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental… functioning and that appropriate assistance is provided when such observation reveals unmet needs. When…deterioration …are observed, the licensee shall ensure that such changes are … brought to the attention of the resident's physician and the resident's responsible person, if any. This requirement was not met as evidenced by: Based on interviews and record reviews the licensee failed to ensure that appropriate assistance was provided to R1 when changes in their physical and mental functioning, R1 was observed which posed an immediate risk to the health, safety and personal rights of residents in care.

Official plan of correction

The administrator agreed to create a plan of correction to ensure that appropriate assistance is provided to residents when observations reveal unmet needs. Proof of corrections will be submitted prior to POC due date, via email, to mario.leon@dss.ca.gov

Deadline recorded: Mar 1, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(b)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (b) In addition to the requirements as specified in Section 87208, Plan of Operation....(2) Safety measures to address behaviors such as wandering, aggressive behavior ....This requirement is not met as evidenced by: Based on interview, observation, and record review, the licensee failed to ensure that the facility prevented the resident from absconging from the memory care unit and being found in the facility parking lot which poses a health risk to residents in care.

Official plan of correction

Administrator Veronica Gomez will develope a security plan to prevent residents of the memory care unit from absconding from the facility without staff or family with the resident.

Deadline recorded: Jan 18, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.655(a)

Regulation authority

HSC

What the official deficiency says

Health and Safety Code (HSC) 1569.655(a) If a licensee..the licensee shall provide no less than 60 days’ prior written notice to the residents or the residents’ representatives setting forth the amount of the increase,..reason..the increase,..general description..additional costs, except for...a change in the level of care of the resident. This subdivision...fee-for-service arrangement with residents. This is not met as evidenced by: Based on interviews with residents and through record reviews, the licensee failed to provide the amount of the increase in a timely manner.

Official plan of correction

Licensee will create a plan that will inform all residents who had not been notified of the new monthly rate change that has taken place on 01/01/2024. Licensee will also create a plan for all future rate amount changes to be presented to residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident. Updated plan will be sent to LPA at Mario.Leon@DSS.CA.GOV

Deadline recorded: Jan 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(b)(2)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia (b) In addition to the requirements as specified in Section 87208, Plan of Operation....(2) Safety measures to address behaviors such as wandering, aggressive behavior ....This requirement is not met as evidenced by: Based on interview, observation, and record review, the licensee failed to ensure that the facility prevented the resident from absconging from the memory care unit and being found in the facility parking lot which poses a health risk to residents in care.

Official plan of correction

Administrator Veronica Gomez will develope a security plan to prevent residents of the memory care unit from absconding from the facility without staff or family with the resident.

Deadline recorded: Sep 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87224(d)

Regulation authority

CCR

What the official deficiency says

87224 Eviction Procedures (d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement is not met as evidenced by: Based on interview, observation, and record review, the licensee failed to ensure the resident was given proper eviction notice prior to resident not being allowed to return from the hospital which pose a health and safety risk to residents in care.

Official plan of correction

Administrator Veronica Gomez will provide additional training to management staff regarding proper eviction notice to residents in care or residents family members.

Deadline recorded: Sep 1, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87506(c)(1)

Regulation authority

CCR

What the official deficiency says

Resident records ...The licensee and all employees shall reveal or make available confidential information only upon the resident's written consent or that of his designated representative. this requirement is not met as evidence by: based on records review and interviews conducted, the licensee did not provide R1's record to authorized representatvie upon request. This poses a personal rights risk to residents in care.

Official plan of correction

Administrator shall provide R1's authorized reporesentative with copies of R1's file by POC due date.

Deadline recorded: Aug 24, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report..to the licensing agency and to the person responsible.. within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include..attending physician's name, findings, and treatment, if any; and disposition of the case. This is not met as evidenced by lack of paper trail between reporting party and licensee.

Official plan of correction

Veronica Gomez and LPA have agreed upon the following: Facility will ensure there to be an in-house LIC624 CHECKLIST, which will include patient name, date, who was informed/included in the conversation. The facility will also fax LIC624 to licensing, along with a copy of the in-house LIC624. The facility will have an in-staff meeting, with a time length and sign-in sheet of those who've attended, related to CCR 87211(a)(1) which shall include witnessed AND unwitnessed falls that occur in the facility as well as admittance to any outside facility, location and contact details. Updated information will be sent via email at Mario.Leon@DSS.CA.GOV

Deadline recorded: Aug 17, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(C)(5)(A)

Regulation authority

CCR

What the official deficiency says

87705:Care of Persons With Dementia; C:Licensees who accept and retain residents with dementia...(5) Each resident with dementia shall have an annual medical assessment ...(A) When any medical assess...This requirement is not met as evidenced by: Licensee/Administrator failed Based on interviews, observations and records the licensee failed to tMaintain a medical assessment and re-appraisal which resulted in Resident #1’s multiple falls due to the need for appropriate supervision by staff for safety.

Official plan of correction

Licensee/Administrator agreed to comply with Regulations and conduct in-service training to ensure facility staff have a complete understanding of appropriate care and supervision with residents being left alone (without appropriate supervision). Licensee/Administrator agreed to submit a verification of completion to CCLD/El Segundo ASC Regional Office by POC due date on 09/23/2022.

Deadline recorded: Sep 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

87466 Observation of the Resident. The Licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional...Licensee/Administrator failed to observe or conduct - at least annually - an assessment.. BasBased on interviews, observations and records the licensee failed to observe or conduct - at least annually - an assessment or re-appraisal of Resident #1’s level of care during the time Resident #1 lived at the facility when there were notable changes in R1 car needs.

Official plan of correction

Licensee/Administrator will review Title 22 Regulations, Section 87466 and submit a detailed written plan on how the facility will document and address changes in the resident(s) condition. This plan is due to the CCLD/El Segundo ASC Regional Office by POC date of 09/23/2022.

Deadline recorded: Sep 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87405(D)(1)

Regulation authority

CCR

What the official deficiency says

87405 Administrator - Qualifications and Duties: D; By retaining a resident without maintaining a medical assessment... This requirement is not met as evidenced by: Licensee/Administrator did not display knowledge of requirements Based on inteviews, observations and records Licensee/Administrator did not display knowledge of requirements for providing care and supervision appropriate to Resident #1 who had a high, fall-risk history.

Official plan of correction

Licensee/Administrator will read Title 22, Section 87405(d)(1) “Administrator – Qualifications and Duties”

Deadline recorded: Sep 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(A)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation (A) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on interviews, observations and records the licensee failed to ensure that the facility is kept free from roaches. This poses a potential health & safety risk to residents in care.

Official plan of correction

Licensee shall contact the pest control company to develop a plan to eradicate roaches in the facility. Licensee shall submit the plan to licensing by the POC date.

Deadline recorded: Jun 17, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)

Regulation authority

CCR

What the official deficiency says

Incidental, Medical, and Dental Care: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: Meds not given to R1: Oxycodone (3x a day as needed) on 01/13/22, 01/18/22, 01/20/22, 01/24/22, 01/25/22, 01/29/22. (Cont) Fentanyl (every 72 hours) on 01/04/22, 01/07/22, 01/10/22, 01/19/22, 01/25/22, 01/28/22, and 01/31/22 at 8:00 a.m. Methadone (every 6 hours) on 01/01/22, 01/02/22, 01/08/22, 01/15/22, 01/16/22, 01/22/22, 01/23/22, 01/29/22, 01/30/22.

Official plan of correction

Licensee/Administrator agreed to comply with the Regulations and conduct an in-service training for all facility staff administering medication to the residents. Licensee/Administrator agreed to submit their verification of completion to CCLD/El Segundo ASC Office by POC due date 04/19/22.

Deadline recorded: Apr 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(h)(6)(A-F)

Regulation authority

CCR

What the official deficiency says

Incidental, Medical, and Dental Care: (6) The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident is maintained for at least one year and includes: This requirement is not met as evidenced by: A review of R1's MAR for the month of January 2022 did not document (staff initials) Oxycodone, Fentanyl, Methadone, Tramadol, Gabapentin were administered to the resident.

Deadline recorded: Apr 12, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87705(C)(3)(A)

Regulation authority

CCR

What the official deficiency says

87705 Care of Persons with Dementia :(c) Licensees who accept and retain residents with dementia..(3) In addition to...(A) Dementia care including, but not limited to, knowledge about hydration, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living; Based on observation, interviews facility faciled to clean R1 face after drinking cocnut water and failed to notice ants in R1 bed which poses an immediate health, safety risk to residents

Official plan of correction

Administrator to develop a training plan for staff that work with residents that have dementia and submit plan to LPA no later than 8/27/2021 Administrator to develop a training plan for staff to work with residents that have dementia and need to be bathe or washed and submit plan to LPA no later than 06/10/2022

Deadline recorded: Aug 27, 2021. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

85072(b)(2)

Regulation authority

CCR

What the official deficiency says

85072 Personal Rights:(B)The licensee shall insure that each client is accorded the following personal rights.(2)To have the facility inform his/her relatives and authorized representative.... Based on observation, interviews, video, facility failed did meet resident's hygiene needs which posed an immediate health, safety risk to residents

Deadline recorded: Jun 10, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation:(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.This requirement is not met as evidenced by: Based on observation, interviews facility faciled to control ant problems and LPA Calderon witness ant problems in room 103 which poses an immediate health, safety

Official plan of correction

TAdministrator will contac pest control for the best options to treat the facility and will provid a outline of a POA by the due date.ining of staff and updated DSS no later than 06/15/2021

Deadline recorded: Jun 15, 2021. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468(a)(2)

Regulation authority

CCR

What the official deficiency says

87468 Personal Rights:(a) Residents in residential care facilities for the elderly shall have personal rights which include, but are not limited to, those listed in Sections 87468.1, Personal Rights of Residents in All Facilities,..(1) " Privately operated facility " means a residential care facility for the elderly that is licensed to an individual, firm, partnership. his requirement is not met as evidenced by: Based on observation, interviews and video it is confirmed that there were ants on R1 face and body and ant issues for the total facility which poses an immediate health, safety

Official plan of correction

Adminsitrator will confirm all staff training in personal rights in residents in care. Adminstrator will provide proof and training and sign in sheet for all staff by POC due date of 6/11/2021

Deadline recorded: Jun 11, 2021. A deadline is not proof that correction was completed.