197608129-11-5-2024-29-AS-KLOZ-DBD8NE-20241125213950

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 11/05/2024
Date Signed: 11/05/2024 05:01:49 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
10/31/2024 and conducted by Evaluator Erica Mosley

COMPLAINT CONTROL NUMBER: 29-AS-20241031111659

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: 86	DATE:	11/05/2024
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Rizaandrea Vitug - Assistant Administrator		TIME COMPLETED:	05:10 PM

ALLEGATION(S):

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Staff do not ensure that resident's incontinence needs are met.
Staff do not provide resident with housekeeping services.
Staff do not routinely monitor resident.
Staff do not serve residents food of good quality.
Staff do not treat resident with dignity and respect.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Erica Mosley conducted an unannounced initial 10-day complaint visit to investigate the above allegation. Upon arrival at 9:50 a.m. LPA Mosley was greeted by front desk staff and Assistant Administrator who called the Executive Director to inform them of the visit. The LPA met with Assistant Administrator Rizaandrea Vitug and Manager, Joselito Vitug explained the reason for the visit. The Executive Director was unable to attend today and designated staff to sign the report.

On 10/31/2024, the Department received a complaint regarding the following allegations, Staff do not ensure that resident's incontinence needs are met, Staff do not provide resident with housekeeping services, Staff do not routinely monitor resident, Staff do not serve residents food of good quality, and Staff do not treat resident with dignity and respect. LPA toured the physical plant areas inside and outside to ensure there are no immediate health and safety hazards and facility is in compliance with Title 22 Regulations.

Report Continued on LIC9099C... 2nd page

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

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 5

Control Number 29-AS-20241031111659

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: 11/05/2024

NARRATIVE

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2nd page
On the allegation, Staff do not ensure that resident's incontinence needs are met, it is the concern of the Reporting Party (RP) that the facility is not addressing Resident #1’s (R1) incontinence needs and R1 was left soiled and had to clean up themselves. To investigate this complaint, LPA conducted in person interviews with the Assistant Administrator, Manager, five (5) staff members, and seven (7) residents between 10:39am – 2:50pm. LPA attempted to interview R1 during the inspection, but they refused to be interviewed at this time. LPA also obtained pertinent documents to the investigation and reviewed facility records.

Interviews with staff revealed that incontinent residents are checked frequently. Staff do rounds to check on incontinent residents every two hours. It was noted that most incontinent residents use their call button when they need assistance or need to be changed. Staff are quick to respond to resident calls and assist in a timely manner. Interviews with incontinent residents revealed that they are regularly monitored and assisted. They are attended to in a timely manner and have no issues with the time response that staff come to assist them as it is relatively quick. Staff interviews also revealed R1 does need assistance with incontinent care although they were not aware of R1 ever being soiled and needing assistance with incontinent care and staff not providing it. Based on information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Staff do not ensure that resident's incontinence needs are met is deemed unsubstantiated at this time.

On the allegation, Staff do not provide resident with housekeeping services, it is the concern of the Reporting Party (RP) that the facility is not providing housekeeping services for R1. To investigate this complaint, LPA conducted in person interviews with the Assistant Administrator, Manager, five (5) staff members, and seven (7) residents between 10:39am – 2:50pm. LPA attempted to interview R1 during the inspection, but they refused to be interviewed at this time. LPA also obtained pertinent documents to the investigation and reviewed facility records.

Report Continued on LIC9099C...3rd page

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 29-AS-20241031111659

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: 11/05/2024

NARRATIVE

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3rd page Interview with staff revealed that the resident rooms are cleaned on a daily basis. Each room on both floors receive basic cleaning services consisting of trash being thrown out, bed being check if sheets need to be replaced due to accident, bed being fixed, carpet vacuumed, and bathroom is wiped down. Once all rooms have received the basic cleaning service 5-7 rooms receive a deep clean with all rooms receiving a deep clean weekly. The deep clean consist of sheets being replaced, carpets being shampooed, rooms being dusted, surfaced wiped down, refrigerator being cleaned, bathroom being cleaned, sink, toilet, shower along with the basic services. Documents obtained support that the facility has a set schedule of rooms being deep cleaned on a weekly basis. Resident interviews revealed that staff come daily to clean their rooms. Resident interviews support that their rooms are cleaned regularly on a daily basis. During the inspection, the LPA attempted to view R1’s room but R1 did not want any visitors at this time. Based on information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Staff do not provide resident with housekeeping services, is deemed unsubstantiated at this time.
On the allegation, Staff do not routinely monitor resident, it is the concern of the Reporting Party (RP) that the facility is not routinely monitoring R1. To investigate this complaint, LPA conducted in person interviews with the Assistant Administrator, Manager, five (5) staff members, and seven (7) residents between 10:39am – 2:50pm. LPA attempted to interview R1 during the inspection, but they refused to be interviewed at this time. LPA also obtained pertinent documents to the investigation and reviewed facility records.
Interview with staff revealed that residents are check on periodically during mealtimes, and for those who are not at meals are check on in their rooms. Residents are monitored and checked on about every two (2) hours. Resident interviews revealed that staff periodically check in on them during mealtimes or in their rooms. Resident interviews support that staff are checking in on them periodically. Documents obtained revealed that every time staff come to a resident room a bar code is scanned documenting how many times staff enter the resident’s room. Based on information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Staff do not routinely monitor resident is deemed unsubstantiated at this time.
Report Continued on LIC9099C...4th page

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 29-AS-20241031111659

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: 11/05/2024

NARRATIVE

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4th page

On the allegation, Staff do not serve residents food of good quality it is the concern of the Reporting Party (RP) that the facility is not providing quality food to residents in care. To investigate this complaint, LPA conducted a tour of the kitchen and food service, checked refrigerators and food that was being prepared, conducted in person interviews with the Assistant Administrator, Manager, five (5) staff members, and seven (7) residents between 10:39am – 2:50pm. LPA attempted to interview R1 during the inspection, but they refused to be interviewed at this time. LPA also obtained pertinent documents to the investigation and reviewed facility records.

The physical plant tour revealed that the food the facility is all dated and at the time of the visit of good quality. The food that was being prepared for the day was fresh and being prepared with quality ingredients. The food service menu was reviewed and matched what was being served. Interviews with staff revealed that the food is being delivered regularly with fresh and top-quality products. Interviews with residents revealed that the food is of good quality and the facility gives the residents the option to substitute parts of their meal if something is not of their liking. Resident interviews regarding food support that the facility serves tasty, good quality food with options. Based on information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Staff do not serve residents food of good quality is deemed unsubstantiated at this time.

Report Continued on LIC9099C...5th page

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 29-AS-20241031111659

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: 11/05/2024

NARRATIVE

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5th page

On the allegation, Staff do not treat resident with dignity and respect it is the concern of the Reporting Party (RP) that the facility does not respect R1 and makes a lot of noise when in their room. To investigate this complaint, LPA conducted in person interviews with the Assistant Administrator, Manager, five (5) staff members, and seven (7) residents between 10:39am – 2:50pm. LPA attempted to interview R1 during the inspection, but they refused to be interviewed at this time. LPA also obtained pertinent documents to the investigation and reviewed facility records.

Interviews with residents reveled that the staff at the facility are respectful and attentive to the residents needs and residents’ rights. Resident interviews support that the staff are respectful and treat them with dignity and respect had they no concern with staff or with the way they are being treated at the facility. Interviews with staff revealed that they are knowledgeable in resident rights and respect the residents. Based on information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Staff do not treat resident with dignity and respect is deemed unsubstantiated at this time.

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

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Erica Mosley	TELEPHONE: (747) 230-3909
LICENSING EVALUATOR SIGNATURE:	DATE: 11/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/05/2024

LIC9099 (FAS) - (06/04)

Page: 5 of 5