191502216-8-24-2023-28-AS-FFIS-CWM5QS-20231014200956

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 191502216
Report Date: 08/24/2023
Date Signed: 08/24/2023 03:39:11 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, 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
09/15/2022 and conducted by Evaluator Kruz Long

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220915141701

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: 180	DATE:	08/24/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Jill Crowell (Director of Resident Services)		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not respond to resident's call for assistance in a timely manner.
Staff did not provide medical assistance to resident in a timely manner.
Food services are inadequate.
Staff do not ensure resident's special diet is followed.
Staff did not safeguard resident's personal belongings.
Staff threatened resident.
Staff placed unsafe equipment in resident's room.
Facility is in disrepair.
Facility did not follow Covid-19 testing protocols.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint visit to the facility. Upon arrival, LPA met with Jill Crowell (Director of Resident Services) and explained the purpose of the visit. A short time later Eusebio (Sev) Tiendia (Director of Wellness) also met with LPA and assisted with the complaint investigation.

During the initial visit on 09/21/22, LPA obtained a copy of the Staff/Resident rosters, Admission Agreement (R#1) and Charge Statement. LPA also toured the facility with Jill Crowell, interviewed Staff #1 and #2 in the conference room and interviewed Resident #1 (R#1) in their living unit.

During today's visit, LPA obtained a copy of the Staff/Resident rosters and interviewed Residents #2 to #10 in the office.
Continue to LIC9099C....

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

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-20220915141701

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ROYAL OAKS	FACILITY NUMBER: 191502216
	VISIT DATE: 08/24/2023

NARRATIVE

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Regarding allegation: Staff did not respond to resident's call for assistance in a timely manner. Interview with Staff indicate Staff response on a timely manner when a call is made for assistance. Interviews with 9 of 9 Residents also indicate Staff responds to calls for assistance on a timely manner. During a tour of various Resident living units, LPA observed the call system to be operable.

Regarding allegation: Staff did not provide medical assistance to resident in a timely manner. Interview with Staff indicate medical assistance such as appointment setting or transportation is provided upon Resident's request. Interviews with 9 of 9 Residents also indicate medical assistance is provided it needed.

Regarding allegation: Food services are inadequate. LPA toured the kitchen and observed all food are of good quality. Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days is maintained. Interview with Staff indicate food service is adequate. Interviews with 9 of 9 Resident indicate food service is adequate and different food choices are available.

Regarding allegation: Staff do not ensure resident's special diet is followed. Per allegation details, it was alleged the facility is not providing Resident #1 with a special diet. Investigation revealed Resident #1 does not require a special diet and there is no physician's order for a special diet. Interviews with 9 of 9 Residents indicate Residents requiring a special diet is provided with meals based on physician's order.

Regarding allegation: Staff did not safeguard resident's personal belongings. Interview with Staff indicate there has never been a complaint that Staff did not safeguard Resident's personal belongings. Interviews with 9 of 9 Residents indicate their personal belonging are safeguarded and never had an incident of missing items. Per allegation details, Staff damaged one of Resident #1's personal items while conducting repairs to the living unit. Facility immediately reimbursed Resident #1 for the damaged item.

Regarding allegation: Staff threatened resident. Interviews with Staff indicate they have never threatened a Resident nor have they ever witnessed other Staff threaten a Resident. Interviews with 9 of 9 Residents also indicate they have never been threatened by Staff nor have they witnessed Staff threatened a Resident.

Regarding allegation: Staff placed unsafe equipment in resident's room. Interviews with Staff indicate unsafe equipment has never been placed in Resident's room. Interviews with 9 of 9 Resident also indicate Staff has never placed unsafe equipment in Resident's rooms. Continue to LIC9099C....

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220915141701

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ROYAL OAKS	FACILITY NUMBER: 191502216
	VISIT DATE: 08/24/2023

NARRATIVE

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Regarding allegation: Facility is in disrepair. LPA toured the facility and observed the facility to be in good repair including Resident's living units. Interviews with Staff indicate items that need repair is completed in a timely manner. Interviews with 9 of 9 Resident indicate the facility is always clean and in good repair and if an item is broken, an order is placed and maintenance will repair it right away.

Regarding allegation: Facility did not follow Covid-19 testing protocols. During the initial visit, Staff checked LPA's temperature and was provided a Covid-19 questionnaire. Interviews with Staff indicate Covid-19 testing protocols were followed. Interviews with 9 of 9 Residents also indicate Covid-19 testing protocols were followed.

Based on LPA's observations, interviews and record review, the investigation revealed: Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

Exit interview conducted with Eusebio (Sev) Tiendia (Director of Wellness) and a copy of this report provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 08/24/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2023

LIC9099 (FAS) - (06/04)

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