197603385-8-30-2021-28-AS-CYEE-C7CP5L-20210930110051

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603385
Report Date: 08/30/2021
Date Signed: 08/30/2021 03:26:48 PM

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
06/09/2021 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210609143319

FACILITY NAME:	COMMONWEALTH ROYALE GUEST HOME		FACILITY NUMBER:	197603385
ADMINISTRATOR:	KITT, GARY		FACILITY TYPE:	740
ADDRESS:	150 S. COMMONWEALTH AVE		TELEPHONE:	(213) 382-6381
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90004
CAPACITY:	99	CENSUS: 92	DATE:	08/30/2021
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Gary Kitt		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff failed to treat resident with dignity and respect
Staff withholds milk from resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted a subsequent visit to deliver complaint investigation findings. LPA met with Administrator Gary Kitt and explained the purpose of the visit.

The Investigation consisted of the following: On 6/14/21, LPA conducted an interview with Administrator Anna Rempel, Staff 1-4 (S1-4), and Residents 1-2 (R1-2). LPA also obtained copies of Staff and Residents Rosters. On 8/30/21, LPA conducted interviews with Residents 3-8 (R3-8), Administrator Gary Kitt and conducted a tour of facility including Kitchen and food storage. LPA also reviewed R1's file and collected a copy of Physician's Report for Residential Care Facilites for the Elderly, Preplacement Appraisal Information and Resident Appraisal.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

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-20210609143319

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: COMMONWEALTH ROYALE GUEST HOME	FACILITY NUMBER: 197603385
	VISIT DATE: 08/30/2021

NARRATIVE

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Investigation revealed the following: Regarding allegation, Staff failed to treat resident with dignity and respect, it is alleged that a facility staff harasses residents and makes fun of residents. It is also alleged that facility staff follows residents while making fun of residents and says things about residents to other residents. Interview with Administrator Gary Kitt and Assistant Administrator Anna Rempel revealed that facility staff do not at any time harass any facility resident and never make fun of any facility resident. Interviews with facility staff revealed that they treat all facility residents with dignity and respect at all times. S1-4 denied ever harassing any facility resident, or ever making fun of any facility resident. S1-4 also denied ever saying anything about any resident to another resident or anyone else. They all stated that if there is any concern regarding any resident the concern will be brought up to either Administrator Kitt or Ms. Rempel. Interviews conducted with R2-8 revealed that they are satisfied with all the services that they receive at the facility and stated that they have never been harassed by any staff member or made fun of by any staff. R2-8 stated that staff are respectful and stated that facility staff treat them with dignity and respect at all times. LPA observed staff/ resident interactions during visits conducted on 6/14/21 and 8/30/21 and did not observe staff harassing or making fun of any resident. LPA observed interactions to be respectful. Based on interviews conducted with facility staff, facility residents, and LPA observations there was not enough supportive evidence to concur with the reported allegation.

For allegation, Facility staff failed to meet the resident's needs, it is alleged that facility staff refuse to provide resident with milk when resident asks for it. It is also alleged that staff tell other staff members not to extra milk to residents. Interviews conducted with Administrator Gary Kitt and Assistant Administrator Anna Rempel revealed that facility residents are never denied any food item that they request. Both stated that residents received three full service meals along with 2-3 snacks a day and beverages are provided throughout the day and as requested and residents are never denied an extra serving of milk if they request it. Interviews conducted with S1-4 revealed that residents are given 3 meals along with 2-3 snacks a day and they always have access to coffee and water. S1-4 stated that if any resident requests additional milk it will be provided to them. Interviews conducted with R2-8 revealed that they are satisfied with the food service provided at the facility. R2-R8 stated that the food is healthy and satisfying, they have different food options and if they do not want what is on the menu they can request a different meal option. R2-8 stated that breakfast is served everyday and it includes milk and coffee and if they request additional milk at any time during the day it is provided to them. Administrator stated that food is ordered twice a week to ensure that there is enough food in stock for resident's daily dietary consumption. LPA toured the facility kitchen and

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210609143319

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: COMMONWEALTH ROYALE GUEST HOME	FACILITY NUMBER: 197603385
	VISIT DATE: 08/30/2021

NARRATIVE

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observed facility menu and residents having their lunch. LPA observed a sufficient supply of perishable foods and sufficient amount of nonperishable foods. Perishable food was stored in covered containers at the appropriate temperature. Based on LPA observations, and statements gathered from interviews conducted with staff and residents there was not enough supportive evidence to concur with the reported allegation.

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.

Exit interview held. A copy of the report was provided to Administrator Gary Kitt.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 08/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2021

LIC9099 (FAS) - (06/04)

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