197608129-5-24-2021-29-AS-DPEA-C4BNJ8-20210625102952

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 05/24/2021
Date Signed: 05/24/2021 04:30:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/09/2020 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20200709145329

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: 64	DATE:	05/24/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Lori McKay - Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility not meeting residents needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted a subsequent complaint investigation for the above allegation. LPA met with Administrator Lori McKay

During the course of the investigation, LPA conducted a physical plant tour virtually on 07/15/2020 as well as interviewed Administrator. On 5/24/21 LPA conducted interviews with facility staff, residents and other relevant parties. LPA also gathered and reviewed facility documentation pertinent to the allegation.

It was alleged that Facility is not meeting resident’s needs, with specifics on toileting. LPA reviewed and obtained resident records and observed (10) residents required some assistance with toileting. Interviews of those (10) residents revealed there were no immediate or major concerns regarding facility not meeting resident needs, in addition to toileting. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that facility is not meeting residents needs. Therefore, the above allegation is UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

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

LIC9099 (FAS) - (06/04)

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