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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608129
Report Date: 10/05/2023
Date Signed: 10/05/2023 03:27:46 PM


Document Has Been Signed on 10/05/2023 03:27 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:RESIDENCES AT ROYAL BELLINGHAM, THEFACILITY NUMBER:
197608129
ADMINISTRATOR:LORI MCKAYFACILITY TYPE:
740
ADDRESS:12229 CHANDLER BOULEVARDTELEPHONE:
(818) 980-2997
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:96CENSUS: 86DATE:
10/05/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Lito VitugTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sandra Urena conducted an unannounced case management-incident visit at 2:45 p.m. The LPA met with Lito Vitug, Executive Director (ED) and explained the reason for the visit. On 10/05/2023, The LPA received a phone call from the facility administrator to inform of an incident that took place on 10/04/2023 at approximately 2:30 p.m.

At 2:45 p.m., the LPA interviewed the Executive Director, Lito Vitug about the incident and a visit from detectives from the Los Angeles Police Department (LAPD), North Hollywood Detective Division (NHDD). The administrator stated that on 10/04/2023 at approximately 2:30 p.m., three detectives visited the facility to investigate an alleged sexual assault incident on a facility resident. The detectives received the alleged incident report from a staff member at the hospital were the resident was admitted due to an unrelated incident. At the time of the LPA's visit, the ED stated that they had already received a call at approximately 12:30 p.m. from the hospital and the detectives stating that there was a lab error and the hospital had erroneously reported the sexual assault. Consequently the investigation was closed by the LAPD, NHDD. At 3:10 p.m., the LPA contacted the hospital staff to inquire about the information received in regards to the erroneous report. The hospital staff confirmed the information provided. Additionally the hospital staff provided the LAPD report number, and the name and number of the lead detectives. No further investigation is needed at this time.

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

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:
DATE: 10/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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