197603385-12-28-2023-28-AS-FFIS-CZBTJL-20240109134628

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603385
Report Date: 12/28/2023
Date Signed: 12/28/2023 12:03:05 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
12/21/2023 and conducted by Evaluator Valeria Maldonado

COMPLAINT CONTROL NUMBER: 28-AS-20231221163709

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: 88	DATE:	12/28/2023
		UNANNOUNCED	TIME BEGAN:	08:50 AM
MET WITH:	Gary Kitt- Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff stole resident's belonging.
Staff did not safeguard resident's personal belongings.
Staff do not treat resident with dignity and respect.
Staff do not clean resident's room.
Staff do not provide resident with toilet paper.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) V. Maldonado made an unannounced initial complaint visit at the facility for the purpose of investigating the above-mentioned allegations. LPA Maldonado met with Administrator, Gary Kitt, and explained the purpose for the visit.

During today's visit, LPA Maldonado obtained a copy of the resident roster, staff roster, and the facility Theft and Loss Policy. LPA Maldonado also obtained the following records for Resident# 1 (R1): Facesheet, Physician's Report, and Resident Personal Property and Valuables (LIC621), and conducted interviews with Staff# 1-3 (S1-S3) and attempted interviews with Residents# 1-8 (R1-R8).

The investigation revealed the following:
Regarding allegation: Staff stole resident's belonging.
It is alleged that upon 48 hours of moving into the facility, R1 was robbed of coat hangers, a coat rack, a leather jacket, and personal memorabilia by an unknown staff member. (3) of (3) Staff interviewed denied the allegation. (Report continued on LIC9099-C...)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

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-20231221163709

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: 12/28/2023

NARRATIVE

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S3 stated to recall R1 calling the police on the second day of R1 residing here, as R1 stated that someone had stolen a clothing rack. S3 states that police came and staff and police checked R1s room, only to find the clothing rack there. Police left and no report was made due to the item being found. (7) of (8) Residents interviewed could not corroborate the allegation. Per the facility's Theft and Loss Policy, the facility is to document and investigate all alleged and actual theft and loss of personal property. After doing so, staff are responsible for searching for missing items- if items could not be found, an estimate of the value would be assessed, and if the theft amount exceeds $100.00, a report would be filed with appropriate law enforcement agency. This was done by the facility.
Regarding allegation: Staff did not safeguard resident's personal belongings.
It is alleged that (2) unknown residents stole money, medication, and coins from R1, and staff did not do anything about it when R1 reported it. (3) of (3) staff interviewed denied the allegation. Staff stated that reports made by R1 were investigated and R1's items were found by staff. S1 stated that the last thing R1 reported missing was candy. S1 stated that S1 gave R1 $20.00 for the alleged missing candy, although S1 observed that R1 still had that candy. During interviews with residents, R1 admitted to S1 giving R1 $20.00 for the candy. R2 stated to have been roommates with R1 for a few weeks (dates were unspecified). R2 stated that while rooming with R1, R1 accused R2 of stealing R1's medications, candy, and a plant. R2 denied stealing anything and stated that staff helped R1 find R1's alleged missing items. (6) of (8) residents interviewed could not corroborate the allegation.
Regarding allegation: Staff do not treat resident with dignity and respect.
It is alleged that staff speak to R1 as if they are insignificant. (3) of (3) staff interviewed denied the allegation and stated they treat residents with dignity and respect. However, residents sometimes do not treat staff with respect. (4) of (8) residents interviewed denied the allegation and stated that staff treat them well. (3) of (8) residents could not corroborate the allegation.
Regarding allegation: Staff do not clean resident's room.
It is alleged that staff do not clean, sweep, mop, empty the trash, or wash the bathroom for R1, and that on 12/20/23, R1's roommate urinated on the floor and as of the 12/21/23, staff had yet to clean it. Upon entry to the facility, LPA observed staff sweeping and mopping common areas and resident rooms, taking out the trash, and picking up laundry. LPA inspected R1's room and it was not malodorous. The bathroom appeared clean and sanitary, the trash can was empty and the floor was clean- no urine, hazards, or obstructions were observed. (3) of (3) staff interviewed denied the allegation and stated staff provide housekeeping one to two times per week, and as needed. (4) of (8) residents denied the allegation and stated to have no issues with housekeeping services being provided. (3) residents could not corroborate the allegation.
(Report continued on LIC9099-C...)

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20231221163709

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: 12/28/2023

NARRATIVE

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Regarding allegation: Staff do not provide resident with toilet paper.
It is alleged that staff do not provide R1 with toilet paper and has had to purchase their own in the past. (3) of (3) staff interviewed denied the allegation. Staff stated that each room is provided with one to two rolls of toilet paper daily, depending on how many residents reside in the room. Staff stated that additional toilet paper is provided as needed. (4) of (8) residents interviewed denied the allegation and stated that staff provide them with toilet paper and anything else they need, upon request. (3) of (8) residents could not corroborate the 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: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2023

LIC9099 (FAS) - (06/04)

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