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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197603385
Report Date: 01/19/2024
Date Signed: 01/19/2024 01:29:26 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
01/16/2024 and conducted by Evaluator Alma Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240116090448
FACILITY NAME:COMMONWEALTH ROYALE GUEST HOMEFACILITY NUMBER:
197603385
ADMINISTRATOR:KITT, GARYFACILITY TYPE:
740
ADDRESS:150 S. COMMONWEALTH AVETELEPHONE:
(213) 382-6381
CITY:LOS ANGELESSTATE: CAZIP CODE:
90004
CAPACITY:99CENSUS: 88DATE:
01/19/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Anna RempelTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff are not maintaining a complete record for resident.
Staff do not dispense resident’s medication as prescribed.
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 Assistant Administrator Anna Rempel and explained the reason for the visit.

The Investigation consisted of the following: LPA conducted interviews with Assistant Administrator Anna Rempel, Staff 1-3 (S1-3) and Residents 1-8 (R1-8). LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1-8's facility files, R1-8's medications and Medication Administration Records (MARs), S1-3 files and collected copies of R1-8 MARs for December 2023 and January 2024 and other documents pertinent to the complaint investigation. LPA additionally conducted a tour of the facility including medication room.


(See LIC9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
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 3
Control Number 28-AS-20240116090448
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: 01/19/2024
NARRATIVE
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Investigation revealed the following: Regarding allegation, Staff are not maintaining a complete record for resident, it is alleged that medication logs are not properly updated and staff are not tracking the date and time of medication distribution so there is no way of knowing if resident(s) are receiving their medications. Facility allegedly only maintains MARs for some medications and they are incomplete with missing information and the the staff need assistance with organizing their medication records. Interviews conducted with Assistant Assistant Anna Rempel and S1-3 revealed that when medications are given to residents, staff initial each resident MARs for each medication and for each dosage. Staff stated that if a resident refuses to take their medications or are not at the facility due to being out or in the hospital the MARs are completed to indicate why the resident did not take their medications and proper reporting is done to any applicable agencies such as CCLD and other programs. Staff stated that the medications are given to residents as prescribed by the doctor. They stated that if a medication has to be taken with food they ensure that the medications are given to them with their meals. Interviews conducted 8 out of 8 facility residents revealed that they do not have any concerns regarding medication management and indicated that they receive their medications at the appropriate times that they have to take them as prescribed by their doctor. LPA reviewed R1-8's MARs and observed that MARs were properly completed by facility staff after medication administration at the time of LPA visit. LPA reviewed 3 staff files that assist with medication and each file had the required medication administration training documented in their personnel files. LPA observed staff as they were administering medications to facility residents and did not observe anything of concern. LPA review of R1's records revealed that R1 was being given only the medication that was prescribed to them and MARs was properly completed at the time of the visit. LPA also reviewed R1-8's Centrally Stored Medication and Destruction Records and observed the forms to be properly completed. LPA toured medication room and did not observe anything of concern. Based on interviews conducted with facility staff, facility residents, LPA review of records and observations, there was not enough supportive evidence to concur with the reported allegation.

For allegation, Staff do not dispense resident’s medication as prescribed, it is alleged that the facility staff are not giving facility residents their medications and due to that R1 was acting "bizarre" and was confused as to whether they received their medication(s) on 01/11/24. It is also alleged that the facility has had ongoing issues with medication discrepancies. Interview conducted with Assistant Administrator Anna Rempel revealed that facility staff properly administer resident medications at their appropriate prescribed times on a daily basis. Interviews conducted with S!-3 revealed that they administer and give residents their
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20240116090448
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: 01/19/2024
NARRATIVE
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medications daily as prescribed by the doctor. Interviews with 8 out of 8 clients revealed that they get their medications on time everyday and that staff make sure that they take their medications. LPA review of R1-8s MARs revealed that medications have been given to clients. LPA also reviewed R1-8's Centrally Stored Medication and Destruction Records and observed the forms to be properly completed. LPA did not observe R1 to appear as confused during the interview. Based on interviews conducted with facility staff, facility residents, and LPA review of documents there was not enough supportive evidence to concur with the reported allegation.

Although the allegations may have happened or are 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 held. A copy of the report was provided to Assistant Administrator Anna Rempel.
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma GonzalezTELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:

DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3