197608129-4-15-2025-29-AS-KLOZ-DG878M-20250429212635

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 04/15/2025
Date Signed: 04/15/2025 02:31:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
01/03/2025 and conducted by Evaluator Erica Mosley

COMPLAINT CONTROL NUMBER: 29-AS-20250103132331

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: 88	DATE:	04/15/2025
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Lito Vitug - Executive Director Rizaandrea Vitug - Assistant Administrator		TIME COMPLETED:	02:35 PM

ALLEGATION(S):

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Staff did not bathe resident in care
Staff did not change resident's undergarments in a timely manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced subsequent complaint visit to investigate the above allegations. The purpose of this visit is to deliver findings for the above allegations. At 9:48 a.m., LPA was greeted by staff and Assistant Administrator. LPA met with Rizaandrea Vitug - Assistant Administrator (AA) and explained the reason for the visit. The Executive Director (ED) Lito Vitug arrived during the visit.

On 01/03/2025 the Department received a complaint regarding the following allegations, Staff did not bathe resident in care and Staff did not change resident's undergarments in a timely manner. On 01/08/2025 LPA Sandra Urena conducted an unannounced initial 10-day complaint visit. At approximately 9:45 a.m. LPA interviewed the ED and collected documents pertinent to the investigation.

Report continued on LIC 9099-C page 2.....

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 29-AS-20250103132331

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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, THE	FACILITY NUMBER: 197608129
	VISIT DATE: 04/15/2025

NARRATIVE

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(Page 2) Report continued from LIC 9099...
On 02/26/2025 LPA Mosley conducted an unannounced subsequent complaint visit. At 9:40 a.m. LPA along with AA conducted a physical plant tour to ensure there were no immediate health and safety concerns. From 10:30 a.m. - 2:30 p.m. LPA conducted interviews with ten (10) residents and six (6) staff including the ED and obtained copies of pertinent documents relevant to the investigation. On 04/07/2025 at 2:45 p.m. LPA conducted a telephonic interview with Resident #1 (R1).
During today’s visit, at 9:55 a.m. LPA conducted the entrance interview and a brief physical plant tour to ensure there are no immediate health and safety concerns and facility is in compliance with Title 22 Regulations.
On the allegation Staff did not bathe resident in care it is the concern of the reporting party (RP) that the facility staff did not bathe R1 for several days. To investigate this complaint, LPA conducted in person interviews with ten (10) residents and six (6) staff including the ED, conducted a telephonic interview with R1, conducted a file review and record review of facility documents including resident shower schedule, and bath service code log sheet. Interview with R1 revealed that they are bathed regularly at least once a week. They have not had any issues or concerns with the facility staff not bathing them. R1 stated they are in and out of the hospital but when they are at the facility the staff ensure they are bathed. Interviews with residents revealed that they are assisted twice weekly with showers. They are on a weekly shower schedule with specific days during the week where they are assisted with showers. They can refuse showers at any time, but staff will typically try and reschedule the shower for a different time or day. They have not had any issues with receiving a shower or have concerns or issues with the shower care they are provided. Interviews with staff revealed that residents receive showers at a minimum of two (2) times per week. Residents are on a weekly schedule where they have specific days of the week they receive shower assistance. Staff state that R1 receives showers on Mondays and Thursdays regularly however has refused in the past. Staff are unaware of R1 not being bathed as they follow the shower schedule to the best of their ability. Interview with ED revealed that R1 regularly receives showers on Mondays and Thursdays. R1 has recently had some health concerns and has been in and out of the hospital. Due to the irregularity in R1’s availability the shower schedule has adjusted for R1 to accommodate when R1 is at the facility. ED is unaware of R1 not being bathed. Based on information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Staff did not bathe resident in care is deemed unsubstantiated at this time.

Report continued on LIC 9099-C page 3...

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 29-AS-20250103132331

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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, THE	FACILITY NUMBER: 197608129
	VISIT DATE: 04/15/2025

NARRATIVE

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(Page 3) Report continued from LIC 9099...
On the allegation Staff did not change resident's undergarments in a timely manner it is the concern of the reporting party (RP) that the facility staff did not change R1’s undergarments in a timely manner. To investigate this complaint, LPA conducted in person interviews with ten (10) residents and six (6) staff including the ED, conducted a telephonic interview with R1, conducted a file review and record review of facility documents. Interview with R1 revealed that they have no issue with staff response time. R1 did not have any concerns or issues with their undergarments not being changed in a timely manner. Interviews with residents revealed that they are assisted in a timely manner. Staff assist them with changing including undergarments when requested or needed. Staff check on them regularly. They use their call button when requiring assistance. They have no concerns or issues with response time from staff. Interviews with staff revealed that residents who require assistance with Activities of Daily Living (ADL’s) such as changing are checked on every two (2) hours. Residents typically use their call buttons when requiring immediate assistance. Staff state that R1 regularly uses the call button when requiring assistance and is assisted in a timely manner. Staff are unaware of R1’s undergarments not being changed in a timely manner. Interview with ED revealed that residents are checked on every two (2) hours but depending on the resident’s needs can be more often. R1 will typically use their call button when requiring assistance. ED is unaware of R1’s undergarments not being changed in a timely manner. Based on information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Staff did not change resident's undergarments in a timely manner is deemed unsubstantiated at this time.

Exit interview conducted. A copy of the report and appeal rights were provided.

SUPERVISORS NAME: Kasandra Lopez
LICENSING EVALUATOR NAME: Erica Mosley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2025

LIC9099 (FAS) - (06/04)

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