197608129-9-28-2022-29-AS-JAPL-CKN3TW-20221028183236

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 07/13/2022
Date Signed: 09/28/2022 01:24:43 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
08/30/2021 and conducted by Evaluator Teresa Camara

COMPLAINT CONTROL NUMBER: 29-AS-20210830160901

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:	Lito Vitug		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Med techs do not deliver medications to the resident on time.
Med Techs force medication into the mouth of the resident.
Staff are not patient with resident who eats slowly.
Staff do not provide adequate laundry services.
Food service is inadequate.
Staff do not allow resident privacy when talking to family member.
Staff hang up on family member who is trying to call the resident.

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 arrived at the facility at 10:25 a.m. and interviewed the ED at 10:48 a.m. LPA had interviewed Resident 1 (R1), other residents and staff during prior visits.

R1 has an order for crushed medications. R1 requires staff to crush the medication and mix the medication in applesauce in the presence of R1. R1 also requires staff mix water in the applesauce cup two times to ensure all medications are received. Staff comply with R1's requests. In addition, staff come to R1's room to deliver medications on time but R1 will send them away and tell them to return later if R1 is busy doing something else. Staff try to ensure R1 is receiving medications timely but when R1 refuses the administration they cannot always ensure timely administration. R1 has a right to refuse medications, but staff cannot ensure they can deliver it when R1 desires, therefore this allegation R1 is not deliverd medications timely 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-20210830160901

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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In addition, staff assist R1 with taking medications with applesauce and comply with R1's requests to ensure all medications are administered. There is insufficient evidence to suggest staff are forcing R1 to take medications, therefore the allegation staff force medication into R1's mouth is deemed Unsubstantiated at this time.

R1 requires all food is pureed. Staff deliver R1's food to R1's room and set it up as R1 wishes. R1 does not require staff feed them; R1 can feed themself. There is insufficient evidence to suggest staff are not patient with R1 being a slow eater since R1 can feed themself, therefore this allegation is deemed Unsubstantiated at this time. In addition, since R1 requires pureed food, the cooks have done what they can to make the pureed food palatable for R1, even pureéing food separately as R1 has asked. Therefore, this allegation is deemed Unsubstantiated at this time.

LPA spoke with other residents regarding staff allowing privacy when they have visitors and staff receiving phone calls from their family. Most residents have a cell phone so their family and friends call them on the cell. It was noted R1 also has a cell phone. Most residents meet with visitors in their room and are afforded privacy. LPA observed on 07/13/2022, R1 had a visitor in their room and was afforded privacy. R1 chooses to leave the door to their room open. Therefore, there is insufficient evidence to say staff do not allow residents privacy with visitors or hang up on residents' family phone calls. These allegations are deemed Unsubstantiated at this time.

LPA spoke with other residents regarding laundry service. Personal laundry is done once per week. No residents had complaints about the laundry service. LPA spoke with the ED who indicated R1 wants laundry done more often than once per week which was the agreement. The ED says staff do R1's laundry on a more frequent basis in order to appease R1. There is no evidence staff are not doing laundry at least once per week as indicated in the admission agreement, therefore this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and report issued via email.

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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