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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 191502216
Report Date: 02/17/2022
Date Signed: 02/17/2022 12:02:31 PM

Unfounded


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
02/14/2022 and conducted by Evaluator Joe Katrdzhyan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220214115534
FACILITY NAME:ROYAL OAKSFACILITY NUMBER:
191502216
ADMINISTRATOR:ANDREW M SMITHFACILITY TYPE:
741
ADDRESS:1763 ROYAL OAKS DRIVETELEPHONE:
(626) 359-9371
CITY:DUARTESTATE: CAZIP CODE:
91010
CAPACITY:250CENSUS: 188DATE:
02/17/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Director of Wellness / Sev Tienda
Executive Director / Andrew Smith		TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Resident is being financially abused while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Joe Katrdzhyan conducted an unannounced 10 day complaint visit to this facility. Upon arriving at the facility, LPA met with Director of Wellness / Sev Tienda and Executive Director / Andrew Smith who assisted with the visit. LPA Katrdzhyan explained the purpose of today’s visit is to discuss the above mentioned allegation of "Resident is being financially abused while in care".

During today's visit, LPA interviewed the Executive Director, Director of Wellness, Staff #1 (S1) and Resident #1 (R1). Also, copies of the following documents were obtained and reviewed in reference to R1;

• Resident Face Sheet • Physician's Report

The investigation revealed the following;
Allegation: Resident is being financially abused while in care. The details of this allegation states that there is suspicion of possible financial abuse by the Private Caregiver (PC) towards R1. No further information was
Unfounded
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
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 28-AS-20220214115534
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: 02/17/2022
NARRATIVE
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provided.

Based on interviews conducted, the statements obtained did not corroborate with the allegation listed above. There were no concerns observed or reported by facility staff or R1 regarding the PC financially abusing R1. LPA discovered that the PC is not an employee of Royal Oaks and was hired by R1 through an outside agency in 2017. The PC is an employee of Comfort Keeper agency. The PC providing care to R1 has been the same PC since time of hire in 2017. The PC normally works five (5) days per week, between the hours of 8am - 2pm. Facility staff monitor the resident while R1 is with the PC, to ensure the needs of R1 are being met. When the PC is not at the facility, the facility staff are in full control of the care being provided to R1.

Based on the information gathered, the allegation of "Resident is being financially abused while in care" is Unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. Therefore, the complaint allegation is being dismissed.

An exit interview was conducted and a copy of this report was provided to the Director of Wellness.
NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Joe Katrdzhyan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2