075600575-3-11-2022-15-AS-YFLS-CEYVPW-20220601163726

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 075600575
Report Date: 03/11/2022
Date Signed: 03/11/2022 02:47:57 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
03/08/2022 and conducted by Evaluator Lisha Holmes

PUBLIC

COMPLAINT CONTROL NUMBER: 15-AS-20220308144154

FACILITY NAME:	EL CERRITO ROYALE		FACILITY NUMBER:	075600575
ADMINISTRATOR:	GIVENS, SONJA		FACILITY TYPE:	740
ADDRESS:	6510 GLADYS AVENUE		TELEPHONE:	(510) 234-5200
CITY:	EL CERRITO	STATE: CA	ZIP CODE:	94530
CAPACITY:	145	CENSUS: 94	DATE:	03/11/2022
		UNANNOUNCED	TIME BEGAN:	11:55 AM
MET WITH:	Sonja Givens, Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is not following current visitor guidelines

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 03/11/2022 at 11:55 AM, Licensing Program Analyst (LPA) L. Holmes arrived unannounced to conduct an initial 10-day complaint investigation regarding the allegation above. LPA met with Sonja Givens, Administrator and informed her of the purpose for the visit.

During the visit, LPA obtained a Facility Staff and Client Roster, Personnel Report, visitation policy, admission agreement, Contra Costa Health Services congregate guidance form and waiver, and El Cerrito Royale's pick-up/escort waiver.

After interviews were conducted and records were reviewed there was no discrepancies in the records and Interviews. The interviews and records revealed that the facility is allowing visitation per PIN 22-07-ASC. LPA observed common area with visible signage and waivers related to the visitation policy. 3 staff members and 3 residents were interviewed and all stated that the visits should be scheduled in advance, vaccination status is verified, and a COVID-19 test is obtained or administered if applicable along with a waiver.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha Holmes	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

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-20220308144154

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: EL CERRITO ROYALE	FACILITY NUMBER: 075600575
	VISIT DATE: 03/11/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

continued from LIC9099...
All residents that were interviewed have regular visits from family members without any difficulty visiting. The facility provided 5 copies of testing waivers that includes the procedures to follow for COVID-19 quarantining. A mitigation plan is on file in the event there is a COVID-19 outbreak within the facility.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED,
Exit interview conducted and a copy of this report provided to Sonja Givens, Administrator.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) 286-0517
LICENSING EVALUATOR NAME: Lisha Holmes	TELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2