197603385-2-16-2024-28-AS-WSHO-D32PBP-20240304101038

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603385
Report Date: 02/16/2024
Date Signed: 02/16/2024 02:34:36 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
02/13/2024 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240213100003

FACILITY NAME:	COMMONWEALTH ROYALE GUEST HOME		FACILITY NUMBER:	197603385
ADMINISTRATOR:	ANNA REMPEL		FACILITY TYPE:	740
ADDRESS:	150 S. COMMONWEALTH AVE		TELEPHONE:	(213) 382-6381
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90004
CAPACITY:	99	CENSUS: 89	DATE:	02/16/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Anna Rempel		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff do not ensure special diet plans are followed for residents in care

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 allegation. LPA met with Administrator Anna Rempel and explained the reason for the visit.

The investigation consisted of the following: LPA conducted interviews with Administrator Anna Rempel, Staff 1-4 (S1-4) and Residents 1-8 (R1-8). LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1-8's facility files, collected copies of documents pertinent to the complaint investigation. LPA conducted a tour of the facility inside and out including included lobby, dining room, kitchen and food storage. LPA additionally collected copies of facility menus.

(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: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

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-20240213100003

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: 02/16/2024

NARRATIVE

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Investigation revealed the following: Staff do not ensure special diet plans are followed for residents in care, it is alleged that the facility does not serve food for residents who are diabetic and residents who have a special diet must eat whatever the facility serves to the other residents. Interviews conducted with facility staff revealed that the food that is served to residents does meets all residents dietary needs and stated that all servings include grains, protein, fruits and vegetables. Administrator stated that the menu is reviewed and approved by a registered dietician every month. The dietician reviews the menus to ensure that the meals that the facility is serving to residents that follow a special diet are meeting their daily dietary needs as well as the needs of all residents in care. Administrator stated that food is ordered twice a week for facility to ensure that the facility has a sufficient amount of food supply for all residents in care. Interviews conducted with 8 out of 8 residents revealed that they are satisfied with the food service provided at the facility. 8 out of 8 residents stated that the food is healthy and satisfying, they are served different food options and if they do not want what is on the menu they can request a different meal option. 4 residents who were interviewed stated that they follow a special diet due to a health condition and they stated that they are satisfied with the meals that are served at the facility and stated that all meals served are healthy, well balanced and meet their dietary needs and the facility provides healthy alternatives as well as sugar free options and items such as sugar free substitutes. LPA toured the facility kitchen and cafeteria and observed facility menu and residents having their lunch. LPA observed the lunch being served to be well balanced with a selection of fruits and vegetables. LPA observed that the daily menu is posted and reflects what will be served for that day and also observed that there was an adequate supply of food which consisted of 2-day perishables and 7-day non-perishables. Based on LPA observations, LPA review of facility menus, 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 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: 02/16/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/16/2024

LIC9099 (FAS) - (06/04)

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