<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608129
Report Date: 01/09/2025
Date Signed: 01/09/2025 02:51:47 PM

Document Has Been Signed on 01/09/2025 02:51 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/
DIRECTOR:		LORI MCKAYFACILITY TYPE:
740
ADDRESS:12229 CHANDLER BOULEVARDTELEPHONE:
(818) 980-2997
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY: 96TOTAL ENROLLED CHILDREN: 0CENSUS: 89DATE:
01/09/2025
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:02 PM
MET WITH:Lito VitugTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst Trevor Bryne (LPA) conducted an unannounced Case Management inspection regarding a self-reported Unusual Incident/Injury Report (UIR) incident report received. LPA met with Executive Director Lito Vitug at 12:02 PM and explained the reason for the inspection.

On 01/08/2025, Community Care Licensing (CCL) received a self-reported Unusual Incident/Injury Report (UIR) pertaining to an incident that allegedly occurred on 12/29/2024 regarding Resident #1 (R1) and Staff #1 (S1). During today’s visit, the LPA conducted an interview with Executive Director Lito Vitug, conducted a brief physical plant tour, and obtained copies of pertinent information. A referral has been submitted to CCL’s Investigations Branch and Investigator Veronica Padilla has been assigned to this investigation.

No immediate health and safety concerns were observed during the visit. Further investigation is needed. Exit interview conducted and copy of report provided.
Kasandra LopezTELEPHONE: (818) 596-4343
Trevor ByrneTELEPHONE: 747-444-6104
DATE: 01/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1