197608129-1-30-2023-29-AS-JAPL-CS7MXD-20230526095942

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 01/27/2023
Date Signed: 01/30/2023 08:06:19 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS NORTH, 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
08/08/2022 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20220808115628

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: 81	DATE:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Lito Vitug, Manager		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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1. Staff did not meet resident's needs
2. Resident's room has pests

INVESTIGATION FINDINGS:

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Licensing Program Analyst(LPA) Christine Yee conducted an unannounced subsequent complaint visit to conduct further investigation and to deliver the findings of the above allegations. LPA Yee met with Lito Vitug, Executive Director and the reason for the visit was explained.

On August 17, 2022, LPA Teresa Camara conducted an unannounced initial complaint visit regarding the above allegations. During the visit, LPA Camara conducted interviews with Staff #1 and Joey Vitug, Facility Manager. Attempts were also made to interview Resdient #1 and it was unsuccessful. Supporting documents for the complaint was also obtained. Due to insufficient information available at the time of the initial visit, the visit was ended as needs further investigation.
continue of LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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-20220808115628

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: RESIDENCES AT ROYAL BELLINGHAM, THE	FACILITY NUMBER: 197608129
	VISIT DATE: 01/27/2023

NARRATIVE

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LPA Yee conducted a subsequent unannounced complaint visit today to continue the investigation. During today's visit, LPA Yee conducted additional interviews with Joey Vitug, Facility manager, Lito Vitug, Executive Director, Residents #1 through Resident #4, and NOC staff.

The following information regarding Allegation #1 - Staff did not meet Residents needs was obtained. Per information obtained, night staff was called by Resident #1 using a personal phone and was advised that Resident #1 had fallen. Per night staff that was interviewed, staff immediately went to Resident's room and observed Resident #1 on the floor. Resident #1 also informed staff that emergency services had already been called and they were on the way. The two night staff were not able to assist Resident #1 back to bed due to being morbidly obese. Resident #1's medical condition has changed and requires a specialized Hoyer lift for transferring. Resident #1's medical condition is still in the process of being assessed for appropriate placement and is currently not living at the facility. Additional four emergency personnel had to be brought in to assist the two responding emergency personnel lift the resident back into bed since no injuries were sustained.

According to Resident #1, the fall from the bed was the result of Allegation #2 - resident's room has pests. Resident #1 alleges that there was movement felt in the bed and when the bed covers were pulled back, roaches or water bugs were seen running out and startled Resident #1, causing the the resident to fall off the bed. There were no bugs observed in the room but the room was treated as a preventive measure. Per review of the facility records, the rooms and common areas are inspected by maintenance and by their pest control company monthly or as needed. If maintenance discovers any pest activity, it is reported to pest control and the facility is treated. Per review of the facility service reports, for June 2022 through January 3, 2023, they did not observe any pest activity. Per residents interviewed, some have indicated that they do not have any pest problems and some indicated that they would sometimes see a gnat or a bug. The investigation was not able to conclusively determine that the facility has a pest problem therefore Allegation #1 and Allegation #2 is UNSUBSTANTIATED.

Exit interview was conducted with Lito Vitug and a copy of this report was provided.

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

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