197608129-5-12-2023-29-AS-JAPL-CRVMLF-20230516094216

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 05/12/2023
Date Signed: 05/12/2023 03:06:21 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
05/08/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20230508122552

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: 87	DATE:	05/12/2023
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Lito Vitug		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff are not cleaning resident's room.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Sandra Urena conducted an initial unannounced visit to investigate the allegation listed above. The LPA met with Managers Joey Vitug and Julio Vitug and explained the reason for the visit.
LPA Urena and Manager Joey Vitug conducted an inspection of the physical plant, and randomly selected and inspected 10 rooms from 1:10 p.m. to 2:20 p.m. The LPA interviewed staff at 12:55 p.m. The LPA interviewed the complainant on 05/11/2023 at 4:15 p.m.

On the allegation that the ‘Facility staff are not cleaning resident's room’ it is the complainant’s concern that the facility staff spend a very short period of time cleaning the residents’ rooms, and that several furniture items are dusty and need cleaning. To investigate the allegation the LPA interviewed staff about the daily, and deep cleaning procedures.
Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

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-20230508122552

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: 05/12/2023

NARRATIVE

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The staff interviews revealed that rooms are cleaned daily by dusting, making the beds, cleaning the bathrooms, and disposing of the trash. Refrigerators get cleaned once a week or depending on the resident needs. Sometimes residents do not want staff to clean their refrigerators. Deep cleaning is done weekly and monthly, and is described as vacuuming of the carpet thoroughly, blinds or curtains cleaned, and refrigerators deep cleaned. The LPA and the manager conducted an inspection of 10 randomly selected rooms. Ten, out of ten rooms appeared to be clean, dressers dusted, and refrigerators clean at the time of the inspection.

Based on the information obtained through interviews and observation, there is not sufficient evidence to support that allegation that Facility staff are not cleaning residents’ rooms. Therefore, this allegation is deemed to be Unsubstantiated at this time.

Exit interview was conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2023

LIC9099 (FAS) - (06/04)

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