197603385-2-1-2024-28-AS-RORN-D27NTQ-20240206094506

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603385
Report Date: 02/01/2024
Date Signed: 02/01/2024 03:48:32 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
01/24/2024 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240124140408

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:	02/01/2024
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Anna Rempel		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Licensee does not ensure facility has a certified administrator

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. LPA met with Administrator Anna Rempel and explained the reason for the visit.

The Investigation consisted of the following: LPA conducted an interview with Administrator Anna Rempel and obtained copies of Staff and Resident Rosters. LPA reviewed Administrator Rempel facility file and collected a current copy of Residential Care for the Elderly Administrator Certificate.

(See LIC9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

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-20240124140408

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: COMMONWEALTH ROYALE GUEST HOME	FACILITY NUMBER: 197603385
	VISIT DATE: 02/01/2024

NARRATIVE

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Investigation revealed the following: Regarding allegation, Licensee does not ensure facility has a certified administrator, it is alleged that Administrator Gary Kitt's administrator certificate is expired and the facility is currently operating without an active administrator to manage the facility. Interview conducted with Administrator Anna Rempel revealed that as of January 1, 2024 she is the administrator of the facility. She stated that she provided Community Care Licensing Division (CCLD) with the required documents needed to update the change of administrator as previous Administrator Gary Kitt retired as of 12/31/23. On 12/01/23, CCLD did receive a request for administrator change along with required documents and that packet is currently under review. LPA Gonzalez will review all submitted documents for change of administrator and will update the change once review of paperwork is finalized. LPA reviewed Administrator Rempel's current copy of Residential Care for the Elderly Administrator Certificate which has an expiration date of 06/11/24. Based on interviews conducted with facility staff, and LPA review of documents 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 Anna Rempel.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

LIC9099 (FAS) - (06/04)

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