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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 107203215
Report Date: 02/28/2022
Date Signed: 02/28/2022 02:39:45 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/11/2021 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20211011084147
FACILITY NAME:ROYAL CAREFACILITY NUMBER:
107203215
ADMINISTRATOR:RIGON, RUDY G.FACILITY TYPE:
740
ADDRESS:2768 PURVIS AVE.TELEPHONE:
(559) 324-8792
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 4DATE:
02/28/2022
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Assistant Administrator, Aurora RigonTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Resident is not receiving P & I funds while in care.
INVESTIGATION FINDINGS:
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On 02/28/2022, Licensing Program Analyst (LPA) A. Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and reqeusted to meet with the Administrator. Facility staff contacted Administrator, Aurora Rigon who arrived a short time later.

Today's inspection included staff interviews and records review.

Interviews with staff and record reviews revealed that the facility stores cash resources for 2 out of 4 residents in care in one shared bank account. Administrator was unable to provide an accurate bank statements reflecting the current balance for resident R1. Per Administrator, residents do not withdraw money from the account and do not request money. Administrator will withdraw money from the shared account and give the money to residents when residents go on an outing with family.

CONTINUED TO LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2022
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 4
Control Number 24-AS-20211011084147
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: ROYAL CARE
FACILITY NUMBER: 107203215
VISIT DATE: 02/28/2022
NARRATIVE
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It was found during records review, that R1 has two account ledgers on file each showing a different account balance. Administrator is unable to provide bank records for transactions of cash resources deposited in and drawn from the account.

Based on interviews conducted and record review, the preponderance of evidence standard has been met, therefore the allegations: Resident is not receiving P & I funds while in care is found to be SUBSTANTIATED.

A deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6, see attached LIC9099D.

An exit interview was conducted. A Plan of Correction was reviewed and developed with the Administrator. A copy of this report and appeal rights will be provided via email due to COVID-19 precautionary measures. Report signed on-site by facility representative.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/11/2021 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20211011084147

FACILITY NAME:ROYAL CAREFACILITY NUMBER:
107203215
ADMINISTRATOR:RIGON, RUDY G.FACILITY TYPE:
740
ADDRESS:2768 PURVIS AVE.TELEPHONE:
(559) 324-8792
CITY:CLOVISSTATE: CAZIP CODE:
93611
CAPACITY:6CENSUS: 4DATE:
02/28/2022
UNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Assistant Administrator, Aurora RigonTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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9
Facility staff verbally abuses resident(s) while in care
INVESTIGATION FINDINGS:
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On 02/28/2022, Licensing Program Analyst (LPA) A. Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and reqeusted to meet with the Administrator. Facility staff contacted Administrator, Aurora Rigon who arrived a short time later.

Based on interviews conducted with staff and residents, the allegation: Facility staff verbally abuses resident while in care is UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

No deficiecies issued.

An exit interview was conducted with Administrator. A copy of this report was discussed a provided via email due to COVID-19 precautionary measures. Report sigend on-site.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 24-AS-20211011084147
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ROYAL CARE
FACILITY NUMBER: 107203215
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/28/2022
Section Cited
CCR
87217(g)(1)
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87217 Safeguards for Resident Cash, Personal Property, and Valuables(g)(1): Records of residents' cash resources maintained as a drawing account shall include a ledger accounting (columns for income, disbursements and balance) for each resident, and supporting receipts filed in chronological order. Each accounting shall be kept current. This requirement was not met as evidenced by:
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Licensee agrees to submit a written statement detailing how the facility will maintain accurate records for cash resources and provide the last 6 months of bank statements and account ledgers for residents in care to the Fresno CCL office by 03/28/2022
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Based on interviews and record review, Licensee did not maintain accurate records of cash resources for R1, which posess a potential health and safety risk to client in care.
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Licensee agreed that staff will be trained on requirements of Safeguards for Resident Cash, Personal Property, and Valuables. Documentation of training topics and attendace will be submitted to the Fresno CCL office by 03/28/2022.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4