197608129-1-4-2024-29-AS-KLOZ-CZY3Q5-20240129172634

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 01/03/2024
Date Signed: 01/04/2024 08:45:32 AM

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
12/22/2023 and conducted by Evaluator Sandra Urena

COMPLAINT CONTROL NUMBER: 29-AS-20231222094141

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: 92	DATE:	01/03/2024
		UNANNOUNCED	TIME BEGAN:	12:46 PM
MET WITH:	Lito Vitug		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff emotionally abusing resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst conducted a subsequent unannounced visit to investigate the allegation listed above. The LPA met with Executive Director Lito Vitug and explained the reason for the visit.
On 12/28/2023, Licensing Program Analyst (LPA) Sandra Urena conducted an initial visit to investigate the allegation listed above. LPA Urena met with Administrator Joey Vitug and explained the reason for the visit. At 10:19 a.m., the LPA requested records pertinent to the investigation and at 10:25 a.m. interviewed residents. The LPA determined further investigation was required prior to issuing findings.

On 01/03/2024, LPA Urena conducted additional interviews with the Administrator, staff (S1), and the Executive Director from 1:13 p.m. to approximately 2:25 p.m. Additionally, the LPA interviewed a relative of R1 at approximately 12:16 p.m. The LPA interviewed the Reporting Party (RP) on 12/28/2023 at 9:56 a.m.
Continues on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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-20231222094141

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: 01/03/2024

NARRATIVE

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On the allegation that ‘Staff is emotionally abusing resident’, it is the reporting’s party concern that the resident is being bullied by a staff (S1) at the facility, and the bullying is escalating. The RP stated that the R1 stated to the RP that S1 has told R1 to be ‘quiet’ and ‘shut up’ in front of other people in the lobby. RP stated that they were reporting what R1 reported to them, and that they have not witnessed the bullying, or the emotional abuse. The RP reported the incident because R1 appeared to be depressed and was crying. Furthermore, RP stated that when they asked R1 why they thought the bulling was happening, the R1 stated that they ‘did not know why’, and that they felt that S1 does not like R1.

The LPA interviewed R1, and the interview revealed R1 felt that S1 does not like R1. When asked why they felt S1 did not like R1, R1 stated that there have been occasions, when R1 will ask a question and S1 will reply, ‘I can’t talk with you right now’, and R1 feels that they can’t even ask S1 a question. R1 could not provide specifics of the occasions when they felt R1 was being ignored by S1. R1 added that S1 constantly yells at them in the lobby. When the LPA asked R1 if S1 has yelled to R1 in any other part of the facility (e.g., bedroom), R1 stated, “No, only in the lobby”. When asked what happened when S1 yelled, R1 said that they were just talking to someone else. The LPA asked R1 if there were other residents who have witnessed S1 yelling at R1 in the lobby? R1 provided one name, but added that that witness would not say anything, ‘because they like S1’. The LPA asked R1 how long the yelling has been going for? the R1 stated that they could not tell but added that it happens all the time. R1 added at the end of the interview that they love it here (facility), that everyone is very nice, and R1 likes the ED very much.

The LPA interviewed five residents, and five out of five stated that they have not felt disrespect nor have been yelled at by S1. The LPA interviewed the administrator about the allegation, and the administrator stated that they have not witnessed S1 yell at anyone, and specifically in the lobby area. The LPA interviewed the ED, who stated that they were aware of the situation. The ED stated that R1 tends to get in the middle of other residents’ business while in the lobby, and consequently S1 might have brought it to R1’s attention. Additionally, the administrator and the ED explained that S1 could not yell due to a condition that prevents S1 from talking loudly.

Continues on LIC 9099 C.. page 3

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231222094141

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: 01/03/2024

NARRATIVE

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Page 3.

The interview with the S1 revealed that on more than one occasion, R1 has used inappropriate language/comments out loud about another resident while the residents line up by the nurse’s station in the lobby. The residents line up to get their blood pressure and sugar levels checked by the nurse. Of the eight to nine residents, one resident tends to cut in the line, causing R1 to make remarks about the resident out loud. Per S1, ‘R1 is not even in the line, they are sitting by the window in the lobby when R2 cuts in line; S1 takes care of addressing the resident cutting in line by speaking with them directly. However, R1 still comments out loud, ‘They do that all the time’. The comments made by R1, prompted S1 to tell R1 (while in the lobby), to ‘Stop meddling’. Furthermore, S1 stated that indeed there have been times when R1 has questions, but S1 may be busy attending to other businesses/residents, consequently they might have said to R1 ‘I can’t speak with you now’. There are many occasions when R1 has requested assistance from S1 and S1 has provided the assistance, as part of their job. S1 denied being emotionally abusive or disrespectful to R1 or any other resident.

The LPA spoke with a relative of R1, and stated that they were of the situation as explained by R1. However, the relative has not visited R1 in the facility, they do not live close by. They added that R1 sometimes has a tendency to exaggerate.

Based on the information obtained through interviews and although the allegation may have happened, there is not sufficient evidence to support the allegation. Therefore, the allegation that staff are emotionally abusing residents, is deemed Unsubstantiated at this time.

Exit interview was conducted with the Executive Director. A copy of the report was issued.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra Urena	TELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC9099 (FAS) - (06/04)

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