197608129-6-14-2023-29-AS-JAPL-CTTTKQ-20230717144818

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 06/14/2023
Date Signed: 06/14/2023 03:09:35 PM

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
07/14/2022 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20220714173700

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: 89	DATE:	06/14/2023
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Lito Vitug, Executive Director		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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1. Staff caused injuries to resident.
2. Facility did not prevent resident from being financially abused.
3. Resident is not given a shower.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted a subsequent unannounced complaint visit to conduct further investigation and intially met with Joey Vitug, Facility Manager. Lito Vitug, Executive Director arrived a little later to conduct the visit. The reason for today's visit was explained.

On 7/20/2022, LPA Teresa Camara conducted an unannounced initial complaint visit. During the initial complaint visit LPA Camara conducted a brief facility tour upon arrival at 9:43 a.m. LPA interviewed Resident #1 (R1) at 9:51 a.m., interviewed Staff 1 (S1) at 10:40 a.m., and interviewed the Executive Director at 11:10 a.m. LPA obtained pertinent documents at 10:50 a.m. During the initial visit, it was determined that further investigation is needed to make a finding for the above allegations.

Prior to conducting today's complaint visit, LPA Yee also conduct a telephone interview on 6/13/23 with a family member, identified as Family #1 at 11:52am.

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: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2023

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-20220714173700

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: 06/14/2023

NARRATIVE

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On today's visit, LPA Yee conducted another interview with the Executive Director at 10:34am and Staff #1 at 9:42am to obtain additional information and clarification for the information obtained by LPA Camara on the initial visit conducted on 7/20/22 and Staff #2 at 11:14am. Family #1 was also contacted via telephone at 10:19am to obtain additional information.

Per information obtained from interviews conducted regarding allegation #1 - staff caused injuries to resident, It was alleged that when the facility staff cut Resident #1's beard they left cuts on the resident. Per interviews conducted with the facility staff/caregiver and Family #1, no one observed any cuts on Resident #1. The facility uses an electric razor that has a flat guard that prevents any facial cuts from happening. The razor also does not work if the guard is open. Resident #1 never informed staff and was never heard complaining about any facial cuts. LPA Yee was not able to locate anyone who could corroborate that Resident #1 had cuts.

Regarding Allegation #2 - facility did not prevent resident from being financially abused. Per interviews conducted, Resident #1 alleged that a family member, Family #1, who has power of attorney over the resident, was financially abusing the resident by taking funds from Resident #1's accounts without permission. Per information obtained from interviews, Resident #1 met someone online and claims to be in love and wants to move to the Philippines to be with that person. Resident#1 has been sending funds to the individual and not paying the rent, leaving the family to come up with the money for rent. The family and the facility staff believe that it is a scam and are trying to prevent more funds from going to the person online. Resident#1 believes that the facility is in cahoots with the family. Per Family #1, the family have their own mortgages and financial obligations and they expect Resident #1 to contribute to the facility rent and expenses. Resident #1 had added Family #1 to a new bank account so that Family #1 could assist with managing the resident's money. The monies taken out of Resident's account were used to cover a small portion of Resident #1's rent and expenses and a large portion of the rent was supplemented by Family #1. Family #1 was ensuring that Resident #1 had a place to live and not financially abusing Resident #1. Per Family#1, the resident has more money in the bank account since they have been managing Resident #1's finances.

Continued on LIC9099-C

SUPERVISOR'S NAME: Jeralyn Ann Pfannenstiel	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Christine Yee	TELEPHONE: (747) 230-3890
LICENSING EVALUATOR SIGNATURE:	DATE: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20220714173700

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: 06/14/2023

NARRATIVE

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Regarding Allegation #3 - Resident is not given a shower. Per interviews conducted, Resident #1 is mostly bed bound and needs dialysis treatment 3 times a week. Resident #1 is given bed baths 3 times a week before going for the dialysis treatments. Per interview with Family #1, they visit regularly and have not observed Resident #1 being neglected or dirty. Resident #1 has had a couple of strokes and looks like someone would in the facility without the use of an arm. Resident #1 gets occasional haircuts and hair is sometimes not combed. Per interview with the Staff #2, Resident #1 would be given a shower or bed bath prior to going to dialysis and no resident goes 2 months without being bathed. Services provided to the residents are also documented on the facility's tracking system. A copy of the report was obtained. Per Staff #1, when Resident #1 was counseled by staff and family not to send funds to the person Resident #1 had met online, Resident #1 would have behavior issues and would refuse to bath or eat. Staff would encourage resident to take showers or bed baths.

Based on the information obtained by LPA Camara on the 7/20/22 visit and during today's visit, LPA Yee was not able to establish conclusively that the above allegations had any merits. Therefore the above allegations are unsubstantiated at this time.

Exit interview was conducted with Joey 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: 06/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023

LIC9099 (FAS) - (06/04)

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