197603385-5-3-2025-28-AS-DSIS-DGLPMU-20250512112653

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197603385
Report Date: 05/03/2025
Date Signed: 05/03/2025 10:31:31 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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
04/21/2025 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250421082449

FACILITY NAME:	COMMONWEALTH ROYALE GUEST HOME		FACILITY NUMBER:	197603385
ADMINISTRATOR:	MAYA MNOYAN		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:	05/03/2025
		UNANNOUNCED	TIME BEGAN:	09:19 AM
MET WITH:	Kevin Gonzales Receptionist		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

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Staff do not assist resident with obtaining medical care
Staff do not observe resident for change in condition
Staff do not provide resident with a safe and comfortable environmen
Staff do not ensure that facility is maintained sanitary
Staff do not safeguard resident's personal belongings

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christian Gutierrez conducted a subsequent complain visit in regard to the allegations listed above. LPA met with Administrator Anna Rempel and explained the purpose of the visit.

The investigation consisted of the following: During the initial visit conducted on 04/29/2025, LPA interviewed Administrator, Staff #1- Staff #6, Residents #1 -Residents #8. LPA obtained copies of the following documents: Staff roster, Resident roster, R1-R2 preplacement appraisal information, Physicians reports, Identification and emergency information, and R1’s order summary report. LPA also toured facility and did random room check.

SEE LIC 9099C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2025

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-20250421082449

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: COMMONWEALTH ROYALE GUEST HOME	FACILITY NUMBER: 197603385
	VISIT DATE: 05/03/2025

NARRATIVE

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In regard to the allegation “Staff do not assist resident with obtaining medical care”, it is alleged that R1 had a rash, and staff will not assist with care. During interviews with residents six (6) out of eight (8) residents stated that staff helps them with medical care. R6 stated “I always get what I need”. During interviews with Administrator and staff it was revealed that residents’ medical needs are taken care of staff helps with any and all medical needs. Administrator stated they have a Care Coordinator who is charge of making appointments.

In regard to the allegation “Staff do not observe resident for change in condition”, it is alleged that residents are not being assessed for behavior changes. During interviews with staff, it was revealed that there is a LVN at the facility and that if a staff member notices anything different with residents the LVN will observe and contact physician if needed for new evaluation. S3 stated that if he/she sees a difference with the resident they will notify the med-tech.

In regard to the allegation “Staff do not provide resident with a safe and comfortable environment”, it is alleged that R1 is afraid of roommate and staff will not change rooms. During interviews with residents six (6) out of seven (7) residents all felt the facility was safe and comfortable. R8 stated “It can be overwhelming because some residents have behavioral issues and cuss staff out”. During interviews with staff, it was revealed that R1 wants a private room but because of ambulatory status it has been a challenge. Staff stated they have not heard that residents do not feel safe here. During todays visit LPA was informed that R1 had been moved rooms.

In regard to the allegation “Staff do not ensure that facility is maintained sanitary”, it is alleged that bathrooms in residents’ bathrooms are not cleaned. During interviews with residents seven (7) out of eight (8) all stated that bathrooms are cleaned daily, and that facility is clean. During interviews with staff seven (7) out of seven (7) stated the facility is cleaned daily. S5 stated they have rooms that need to be cleaned three times a day.

SEE 9099C

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2025

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20250421082449

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: COMMONWEALTH ROYALE GUEST HOME	FACILITY NUMBER: 197603385
	VISIT DATE: 05/03/2025

NARRATIVE

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In regard to the allegation “Staff do not safeguard resident's personal belongings”, it is alleged that R1’s money and cigarettes have been stolen from bedroom. During interviews with residents five (5) out of eight (8) have never had anything stolen from there bedrooms. R4 stated that mail has been taken from room. During interviews with staff all stated that residents have said clothes like socks, or t-shirts have been missing but that they are usually found when looked for. Administrator stated that when items are said to be missing, she asks for proof that they had it, but residents can’t provide that. Administrator stated that she can’t accuse anyone without proof.

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 conducted, a copy of the Appeal Rights and this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Christian Gutierrez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2025

LIC9099 (FAS) - (06/04)

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