197608129-6-14-2023-29-AS-JAPL-CU3RWZ-20230725132358

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 06/14/2023
Date Signed: 06/14/2023 03:19:17 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
08/26/2022 and conducted by Evaluator Christine Yee

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20220826120735

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:	01:45 PM
MET WITH:	Lito Vitug, Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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1. Facility did not ensure that resident was adequately fed while in care.
2. Facility did not meet resident's hygiene needs while in care..

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Yee conducted a subsequent unannounced complaint visit to conduct further investigation and 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.

An initial unannounced complaint visit was conducted on 9/1/22 by LPA Teresa Camara. During the initial visit, LPA Camara conducted an interview with the Facility Manager at 10:18 a.m. and reviewed records at approximately 11:00 a.m. Resident 1 (R1) was at the hospital during LPA's visit. It was determined during the initial visit that further investigation was needed to make a finding for the above allegations.

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

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: 06/14/2023

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-20220826120735

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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initial visit conducted on 9/1/22 and Staff #2 at 11:14am.

Regarding Allegation #1 - Facility did not ensure that resident was adequately fed while in care. Per interviews conducted with the Executive Director, Staff #1 and Staff #2, Resident #1 weighs about 230lbs and was well fed. Residents are given other choice of foods to pick from if they do not like the food prepared for each meal. Caregivers are notified by kitchen staff if a resident does not order a meal or if the food tray is picked up untouched by any resident. Caregivers will enquire with the resident why the resident is not eating. Per interviews conducted, Resident #1 would eat the facility food and would also order food through Uber Eats. Resident #1 eats well. Per Staff #1, Resident #1 went through a period where they refused to eat or bath as a result of the staff and family advising Resident #1 not to send money to a person that Resident #1 had met online. Resident #1 felt being ganged up on by everyone. Resident #1 was infatuated and in love with the person. Per Staff #2, Resident #1 would refuse to eat and than would later change their mind and eat. Resident #1 was never left hungry.

Regarding Allegation #2 - facility did not meet resident's hygiene needs while in care. Per information obtained from interviews, Resident #1, who is mostly bed bound and receives dialysis three times a week. Resident #1's routine is to have a bed bath or a shower and is changed prior to going to get dialysis treatment after lunch. Per Staff #1 and Staff #2, on 8/24/22, Resident#1 had been bathed and changed and was transported by ambulance to receive dialysis services. Per Staff #2, Resident #1 left the facility clean, otherwise the ambulance driver would have requested staff clean Resident #1 prior to transportation. Resident #1 must have thrown up during transportation. Upon arrival at the dialysis facility, Resident #1 did not receive dialysis services due to low blood pressure and was transported to the hospital. Based on the information provided, LPA Yee was not able to conclusively determine that the facility failed to meet the hygiene needs of Resident #1 while in the care of the transportation company.

Based on the investigation, the findings of the above allegations are unsubstantiated.

Exit interview was conducted with Joey Vitug since Lito Vitug had to leave the facility during the visit.

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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