197608129-9-28-2022-29-AS-JAPL-CKMVWP-20221028164815

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 07/13/2022
Date Signed: 09/28/2022 01:23:25 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
12/21/2021 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20211221162023

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:	03:55 PM

ALLEGATION(S):

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Facility is not being cleaned sufficiently.
Resident is not being bathed sufficiently.
Not enough staff to meet resident's needs.

INVESTIGATION FINDINGS:

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

LPA conducted a brief physical plant tour starting at 10:25 a.m., an interview with Resident 2 (R2) at 10:35 a.m., an interview with the ED at 10:48 a.m. and an interview with Resident 1 (R1) at 3:23 p.m. LPA had conducted interviews with other residents and staff during previous visits.

During LPA's visits to the facility LPA has observed the overall cleanliness of the facility and residents' rooms to be sufficient. Residents are allowed to decorate their single-occupancy rooms as they wish. The bathrooms, dining room, flooring and carpet all appeared clean. Based on observations and interviews with residents, there is not sufficient evidence to indicate the facility is not being cleaned sufficiently, therefore this allegation is deemed Unsubstantiated at this time.

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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Control Number 29-AS-20211221162023

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: RESIDENCES AT ROYAL BELLINGHAM, THE	FACILITY NUMBER: 197608129
	VISIT DATE: 07/13/2022

NARRATIVE

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LPA interviewed staff and reviewed the file for Resident 1 (R1). R1 has scheduled showers for Tuesdays and Saturdays. However, according to staff R1 is bathed more frequently and on the days and times R1 requests. R1 usually requests showers in the afternoon and will request bedding be changed after being showered or just before being showered. Facility staff do their best to accommodate R1's wishes. Occasionally, R1 will request a morning shower if R1 has an appointment to attend outside of the faculty which is something staff try to accommodate as well. Based on interviews with staff, R1 is bathed more than twice a week. There is no evidence to indicate R1 is not sufficiently bathed, therefore this allegation is deemed Unsubstantiated at this time.

LPA interviewed residents and staff. According to other residents, the staffing at the faciltiy can sometimes be tight but their calls are usually answered in a reasonable amount of time. Staff indicate the same. Staff indicated they try to respond to R1 right away because R1 will act out by removing clothing and walking the hallways if staff do not respond immediately. R1 has also purposely flooded the bathroom by plugging the sink while waiting for staff to respond. Today, 07/13/2022, from 7:00 a.m. to 11:26 a.m. they responded to eight service calls from R1. Based on interviews with residents and staff, there is insufficient evidence to indicate the facility does not have enough staff to meet R1's needs, therefore this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and report issued.

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

LIC9099 (FAS) - (06/04)

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