197603385-2-8-2024-28-AS-FFIS-D3LPP7-20240322112901

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603385
Report Date: 02/08/2024
Date Signed: 02/08/2024 03:05:43 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
01/31/2024 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240131085828

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:	02/08/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Ana Rempel- Administrator		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not safeguard resident's money.
Staff did not provide resident with privacy.

INVESTIGATION FINDINGS:

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

During today's visit, LPA Maldonado obtained a copy of the resident and staff roster, and the following documents for Resident# 1 (R1): Facesheet, Physician's Report, and Resident Personal Property and Valuables sheet (LIC621). LPA also conducted interviews with Residents# 2-9 (R2-R9), and Staff# 1-6 (S1-S6). LPA was unable to interview R1 due to R1 out in the community during the visit.

The investigation revealed the following:
Regarding allegation: Staff did not safeguard resident's money.
It is alleged that a S3 stole $600 on 1/28/24 and $1,000 on 1/29/24 from R1's room, totaling $1,600. LPA was unable to interview R1 to obtain additional information.
(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: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

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-20240131085828

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: 02/08/2024

NARRATIVE

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Per interviews conducted with R2-R9, (8) of (9) residents could not corroborate the allegation. Per staff interviews, (6) of (6) staff denied the allegation. S1 and S2 stated that R1 reported the amount missing to them around the end of January 2024. However, this is not the first time R1 alleges to be missing said quantity of money, which happens to be the amount of rent due. S2 stated that R1 may have reported it to local law enforcement as they visited on 2/7/24 and attempted to speak with R1, but R1 was out in the community at the time. No police report was left by law enforcement and could not be provided. Per R1's Physician's Report, R1 is self-responsible for R1's finances.

Regarding allegation: Staff did not provide resident with privacy.
It is alleged that on 1/30/24, at about 6am, R1 found S3 in R1's room without R1's permission. Per interviews with staff, (6) of (6) denied the allegation. S3 stated to have walked into R1's room with R1's permission, as R1 was awake and they had a conversation. Shortly after S3 left R1's room, S3 stated to have heard R1 telling S1 that S3 was in R1's room without R1's permission and stole R1's money. S3 is unaware of the amount of money R1 accused of S3 taking. S3 denied taking anything from R1's room and is unsure why R1 accused S3 of this. Per resident interviews, (8) of (9) residents denied the allegation and stated they have no issues with staff giving them privacy in their rooms.

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.

An exit interview was held and a copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2024

LIC9099 (FAS) - (06/04)

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