197603385-3-20-2024-28-AS-RORN-D3XLTX-20240402090302

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603385
Report Date: 03/20/2024
Date Signed: 03/20/2024 03:41:18 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
03/18/2024 and conducted by Evaluator Alma Gonzalez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240318151857

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: 91	DATE:	03/20/2024
		UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Anna Rempel		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff pushed resident
Facility staff speaks inappropriately to residents
Facility staff yells at residents

INVESTIGATION FINDINGS:

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***This report serves as an amendment and supersedes the complaint investigation report created on 03/20/24. The reason for amendment is the initial report contained errors on the second and third page of the report. No other changes have been made to the report and findings remain the same.***

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegations. 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 1-3 (S1-3) and Residents 2-9 (R2-9). R1 was not at the facilty during the visit. LPA obtained copies of Staff

(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: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

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-20240318151857

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: 03/20/2024

NARRATIVE

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and Resident Rosters. LPA reviewed R1-9's facility files, and S1-3 files. LPA collected copies of documents pertinent to the complaint investigation. LPA conducted a tour of the facility inside and out which consisted of inspection and observations of the lobby, dining room, medication room, patio and (5) five resident rooms.

Investigation revealed the following: Regarding allegation, Facility staff pushed resident, it is alleged that a facility staff (S3) pushed a facility resident (R1) approximately 3 weeks ago and the incident was witnessed by another facility resident (R2). The alleged incident occurred in the courtyard/ patio area. R1 did not sustain any injuries. Interviews with facility staff revealed that facility staff have not pushed any resident. Staff stated that all residents are always treated with dignity and respect. Staff stated that R1 is very aggressive and does not follow house rules. They stated that R1 is the one that invades staff's personal space and screams and yells at staff and residents. LPA interviewed a total of 8 residents, and 7 residents stated that staff do not push residents. They stated that hey like the facility, they feel safe, staff treat them with respect and they do not have any concerns. 1 out of the 8 residents stated that they did witness S3 push R1 that R1 did not do anything in return and only walked away. 7 residents stated that they did not witness any staff push or chase any resident. R1 was not at the facility at the time of visit. LPA toured the facility and observed residents in the front patio, courtyard and throughout the facility and residents appeared comfortable. LPA did not observe any bruising on any resident and did not observe anything of concern. Based on statements gathered from interviews conducted with staff, residents and LPA observations there was not enough supportive evidence to concur with the reported allegation.

For allegations, Facility staff speaks inappropriately to residents and Facility staff yells at residents, it is alleged that on 03/11/24, a facility staff (S3) yelled at R1 and used profanity towards the same resident. This alleged incident was witnessed by a facility resident (R2) who stated that they heard S3 yell and chase R1. It was additionally reported that S3 yells at other residents and at facility staff. R1 has been served an eviction notice by facility. Interviews conducted with facility staff revealed that all facility residents are treated with dignity and respect at all times, staff do not speak to any resident inappropriately or yell at any resident and/ or staff. Staff also stated that staff have not chased any resident. S3 denied ever speaking inappropriately to R1, yelling at R1 or any other resident and also denied chasing R1. S3 denied ever yelling at any staff. Administrator stated that R1 is very aggressive and continuously does not follow house rules and refuses to pay their rent. She stated that R1 has been served with a 60 day eviction notice on 02/15/24. Staff also stated there is a zero-tolerance policy on abuse and will make a report if they observe any staff verbally

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Alma Gonzalez	TELEPHONE: (323) 981-3973
LICENSING EVALUATOR SIGNATURE:	DATE: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20240318151857

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: 03/20/2024

NARRATIVE

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abusing a resident. Interviews conducted with 7 out of 8 residents revealed that they are satisfied with the services, staff treat them with dignity and respect, staff do not yell at residents and staff do not speak inappropriately to residents. 7 residents stated that they have never seen a staff chase a resident, 1 resident stated that they did hear S3 speak inappropriately to R1, yell at R1 and stated that they did not see the incident but only heard it. 1 resident stated that they did not see S3 chase R1 but has seen S3 push R1 before. R1 was not at the facility at the time of the visit. During the visit, LPA observed staff interacting with residents and did not observe anything of concern. The interactions between staff and residents were observed to be respectful. LPA reviewed R1's file and did observe an eviction letter dated 02/15/24. LPA Gonzalez reviewed all eviction documents, warning notices, and notes regarding R1's behavior and found the eviction notice to be legal. A copy of the eviction notice was provided to R1's placement agency. LPA additionally reviewed staff files and observed that they receive annual training on abuse. Based on statements gathered from interviews conducted with staff, facility residents and LPA record review and 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 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: 03/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/20/2024

LIC9099 (FAS) - (06/04)

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