197603385-3-14-2024-28-AS-RORN-D3QLNX-20240326085505

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603385
Report Date: 03/14/2024
Date Signed: 03/14/2024 12:26:30 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
03/07/2024 and conducted by Evaluator Glenn Trueman

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240307171251

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:	03/14/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Anna Rempel		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Resident was physically abused while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Glenn Trueman 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 and 2 (S1 and S2) and Residents 1-8 (R1-8) from 9:50 AM to 11:45 AM .LPA obtained copies of Staff and Resident Rosters. LPA reviewed R1's facility file, and collected copies of documents pertinent to the complaint investigation.
Interview was conducted with R 1's Case Manager from the VA telephonically at 11:50 AM. and interview was conducted with Conservator for Resident R 1 telephonically at 12:00 PM.
In regards to the allegation Resident was physically abused while in care based on interviews conducted and information gathered it was revealed by R 1's Case Manager that R 1 had been mentally and physically off.
R 1 was only at hospital for a fall and stated that R 1 never mentioned an attack. Stated she had not

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

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-20240307171251

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: 03/14/2024

NARRATIVE

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witnessed any bruises and doubts that the allegation occurred.
Interview with Conservator for R 1 who stated that R 1 had been delusional lately and he only went to the hospital for a fall.
Stated she has no evidence to support the allegation occurred.
Interview with staff who stated that R 1 is very aggressive and loud and tries to hit others with his cane.
Staff have never observed or heard of any resident being harmed physically.
Interview with Resident's R 2- R 8 who all stated that they have never seen or heard of R 1 or any resident being attacked and physically harmed. Stated R 1 will get loud and scream and gets in trouble being bad with people.
All stated that staff do a great job and are very efficient.

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: Glenn Trueman	TELEPHONE: (323) 981-1652
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC9099 (FAS) - (06/04)

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