191502216-9-20-2025-28-AS-FFIS-DN52V6-20251104164326

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191502216
Report Date: 09/20/2025
Date Signed: 09/20/2025 02:15:22 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/16/2025 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250916162947

FACILITY NAME:	ROYAL OAKS		FACILITY NUMBER:	191502216
ADMINISTRATOR:	ANDREW M SMITH		FACILITY TYPE:	741
ADDRESS:	1763 ROYAL OAKS DRIVE		TELEPHONE:	(626) 359-9371
CITY:	DUARTE	STATE: CA	ZIP CODE:	91010
CAPACITY:	250	CENSUS: 30	DATE:	09/20/2025
		UNANNOUNCED	TIME BEGAN:	01:18 PM
MET WITH:	Charge Nurse Anjelica Ponce		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff did not keep resident information confidential.
Unqualified staff are providing care to resident(s) in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 09/20/2025, to deliver findings regarding the above allegations. On 09/18/2025, LPA Ramirez conducted an unannounced initial complaint investigation. Due to time constraints, additional interviews were needed and additional time to review records, a need further investigation was documented. During today’s visit, LPA Ramirez was greeted by Charge Nurse Anjelica Ponce and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Staff Roster, Resident Roster, copies of the following for Resident#1 (R1): physician's report, needs and services care plan, and physical plant tour. LPA Ramirez conducted the following interviews: Staff#1 - 7 interviews (S1 – S7) and Resident#1-3 Interviews (R1- R3).

SEE 9099-C for continued report

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250916162947

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ROYAL OAKS	FACILITY NUMBER: 191502216
	VISIT DATE: 09/20/2025

NARRATIVE

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The investigation revealed the following: regarding the allegation “Facility staff did not keep resident information confidential.” It is alleged staff revealed R1’s confidential medical information to maintenance staff. Seven (7) out of the seven (7) staff interviewed denied this allegation. Interview with S6 revealed a resident’s medical diagnosis or medical condition is not disclosed to them. An interview with S7 revealed maintenance staff do not need to know a resident's medical condition because maintenance only provides repair and maintenance to the buildings and grounds. Three (3) out of the three (3) residents interviewed denied this allegation. Interview with R1 revealed they receive “good care” from staff and felt “safe” at the facility. 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, therefore the allegation is UNSUBSTANTIATED.

Unqualified staff are providing care to resident(s) in care.” It is alleged that maintenance staff are providing direct care and supervision to residents. Seven (7) out of the seven (7) staff interviewed denied this allegation. Interview with S3 revealed maintenance would never assist or provide direct care and supervision to residents due to maintenance staff not being qualified or trained to assist residents. Interview with S7 revealed if they observe a resident requests assistance with anything other than maintenance/repairs, they will call for a nurse or caregiver to assist the resident. Three (3) out of the three (3) residents interviewed denied this allegation. All three (3) residents interviewed revealed that maintenance staff have assisted with repairs to their room but denied that maintenance staff have ever assisted them with activities of daily living. 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, therefore the allegation is UNSUBSTANTIATED.

No deficiencies were cited during this complaint investigation. Exit interview was conducted and a copy of this report was provided.

SUPERVISORS NAME: Fernando Fierros
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:	DATE: 09/20/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2025

LIC9099 (FAS) - (06/04)

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