197603385-2-3-2022-28-AS-MVAO-CCLRPD-20220317131145

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603385
Report Date: 02/03/2022
Date Signed: 02/03/2022 01:14:45 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
01/28/2022 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220128143136

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: 93	DATE:	02/03/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Gary Kitt		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Facility is not following COVID-19 protocol

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 Gary Kitt and Assistant Administrator Anna Rempel and explained the reason for the visit.

The investigation consisted of: LPA conducted an interview with Administrator Gary Kitt and Assistant Administrator Anna Rempel. LPA conducted interviews with Staff 1-3 (S1-3) and Residents 1-6 (R1-6). LPA obtained copies of Staff and Resident Rosters. LPA also conducted a tour of facility which included observations of common areas, lobby, dining room, kitchen and random resident rooms.

(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: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

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-20220128143136

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: 02/03/2022

NARRATIVE

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Investigation revealed the following: Regarding allegation, Facility is not following COVID-19 protocol, it is alleged that facility residents who have tested negative for COVID-19 are mandated to quarantine in their rooms. The residents are only allowed out of their room to smoke cigarettes or to go to a medical appointment. It is also alleged that Administrator Anna Rempel stated that facility residents who have tested negative for COVID-19 are also placed in quarantine and stated that all residents are in quarantine. Interview with both Administrator Gary Kitt and Assistant Administrator Anna Rempel revealed that only COVID-19 positive residents are placed in quarantine and stated that they are following current LA County Department of Health guidelines and following all guidance given by Community Care Licensing (CCLD) and Centers for Disease Control (CDC). They stated that residents who have tested negative are not quarantined and are just encouraged to follow social distancing guidelines and to always wear their masks when out of their rooms. They stated that negative residents are able to come out when they want and stated that residents are able to use public transportation if they chose but do offer other transportation options to mitigate the spread of COVID-19 within the facility. They stated that the facility conducts proper screening to all visitors and medical personnel that come into the facility. S1-3 stated that residents are able to go out of their rooms and are not quarantined. S1-3 stated that only COVID-19 positive residents are quarantined. 5 out of 6 residents stated that they do not have any concerns with how the facility is handling the COVID-19 protocol. 5 of 6 residents stated that they are able to come out when they want and are encouraged by staff to keep six feet distance and to always wear a mask to avoid getting sick with COVID-19. 5 of 6 residents stated that they do not have any concerns with the facility and are satisfied with all services as well as the way the facility staff are handling the current COVID-19 positive cases that are currently active in the facility. 1 of 6 residents refused to be interviewed. LPA toured the facility and observed that there are signs encouraging mask use, washing of hands, and social distancing throughout the facility, LPA observed sanitizer throughout the facility. LPA observed residents out in the common areas and also outside in the patio area. LPA observed residents coming into the facility from the community. LPA observed visitors being screened before entering the facility. Based on interviews conducted with facility staff, facility residents and LPA observations, 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 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: 02/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2022

LIC9099 (FAS) - (06/04)

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