197608129-7-14-2022-29-AS-JAPL-CJHNRN-20220922104149

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 07/13/2022
Date Signed: 07/14/2022 05:26:40 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/05/2022 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20220705153455

FACILITY NAME:	RESIDENCES AT ROYAL BELLINGHAM, THE		FACILITY NUMBER:	197608129
ADMINISTRATOR:	LORI MCKAY		FACILITY TYPE:	740
ADDRESS:	12229 CHANDLER BOULEVARD		TELEPHONE:	(818) 980-2997
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	96	CENSUS: 80	DATE:	07/13/2022
		UNANNOUNCED	TIME BEGAN:	10:25 AM
MET WITH:	Lido Vitug		TIME COMPLETED:	04:33 PM

ALLEGATION(S):

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Facility has video cameras in resident room

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Teresa Camara conducted an unannounced initial complaint investigation at the facility. LPA met with Executive Director (ED) Lito Vitug and explained the reason for the visit.

LPA arrived at the facility at 10:25 a.m. and observed video feed of cameras in the following locations: front door, back entrance, lobby area, front desk area, and two medication rooms. LPA interviewed the ED at 10:48 a.m. who stated there are no operable cameras in the hallways or facility perimeter and there are no cameras placed in any residents' rooms. At 3:23 p.m. LPA toured the room of Resident 1 (R1) and found no evidence of cameras in R1's room.

Based on LPA's observations, the above noted allegation is deemed Unsubstantiated at this time. Exit interview conducted and report issued via email to the ED.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Teresa Camara	TELEPHONE: 818-326-4019
LICENSING EVALUATOR SIGNATURE:	DATE: 07/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2022

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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