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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200082
Report Date: 10/10/2022
Date Signed: 10/10/2022 03:40:52 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/18/2022 and conducted by Evaluator Lisha Holmes
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20220818153416
FACILITY NAME:ROYAL COLONY IN BERKELEYFACILITY NUMBER:
019200082
ADMINISTRATOR:ALEGRE, FELIX JAMESFACILITY TYPE:
735
ADDRESS:1606 ALCATRAZ AVE.TELEPHONE:
(510) 655-8221
CITY:BERKELEYSTATE: CAZIP CODE:
94703
CAPACITY:32CENSUS: 28DATE:
10/10/2022
UNANNOUNCEDTIME BEGAN:
03:05 PM
MET WITH:Felix James Alegre, AdministratorTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff unlawfully evicted a resident
INVESTIGATION FINDINGS:
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On 10/10/2022 at 3:05 PM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to deliver the complaint findings for the above allegation. LPA met with Staff #1 (S1) and explained the purpose for the visit.

Client #1 (C1) was admitted to the hospital on 07/26/22. Records and interviews with Witness #1 (W1) revealed that C1 temporarily needed oxygen during his/her hospital stay. On 08/03/22, C1 was cleared to be released by his/her physician as medically stable without the need of supplemental oxygen. According to interviews conducted with S3, S4, and W1, there were discrepancies surrounding C1’s needs and services. A reappraisal by the facility and physician was completed on or around 08/24/22. C1 was discharged from the hospital on 08/25/22 and returned to the facility. C1’s case manager and S3 are working closely to review alternative placement in the event C1’s medical condition changes. There wasn’t an unlawful eviction or notice of eviction given to C1. The facility has procedures in place to continually monitor and document C1’s medical conditions.
continued on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
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
Control Number 15-AS-20220818153416
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: ROYAL COLONY IN BERKELEY
FACILITY NUMBER: 019200082
VISIT DATE: 10/10/2022
NARRATIVE
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...continued from LIC9099

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted. A copy of this report provided to Administrator Felix James Allegre.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Lisha Holmes
LICENSING EVALUATOR SIGNATURE:

DATE: 10/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2