197608129-1-12-2026-29-AS-KHEN-DUJV9M-20260529161431

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 01/12/2026
Date Signed: 01/12/2026 05:02:24 PM

Substantiated

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
01/08/2026 and conducted by Evaluator Quoc Huynh

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20260108161808

FACILITY NAME:	RESIDENCES AT ROYAL BELLINGHAM, THE		FACILITY NUMBER:	197608129
ADMINISTRATOR:	ANGELITO VITUG		FACILITY TYPE:	740
ADDRESS:	12229 CHANDLER BOULEVARD		TELEPHONE:	(818) 980-2997
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	96	CENSUS: 88	DATE:	01/12/2026
		UNANNOUNCED	TIME BEGAN:	09:47 AM
MET WITH:	Rizaandrea Vitug - Assistant Administrator Angelito Vitug - Executive Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Licensee did not ensure facility was free from pests

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Quoc Huynh conducted an initial complaint visit for the above allegation. The LPA arrived at 9:47AM and met with Assistant Administrator (AA) Rizaandrea Vitug. The Executive Director (ED) Angelito “Lito” Vitug arrived at 10:50AM. Entrance interview conducted.

During today’s visit, the LPA and AA conducted a physical plant tour at 9:52AM. Between 10:38AM and 2PM, the LPA reviewed and obtained pertinent documents and interviewed six (6) staff, one (1) family member, the AA, and the ED. The following was then determined:

Report Continued on LIC 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

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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Control Number 29-AS-20260108161808

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: 01/12/2026

NARRATIVE

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Allegation: “Licensee did not ensure facility was free from pests”

It was reported that Resident #1 (R1) previously had cockroaches observed in their bathroom and currently had cockroaches in their bedside dresser. During a tour of R1’s room, the AA opened the bedside dresser that was utilized as a nightstand, and multiple cockroaches were observed to scatter. The LPA observed cockroach droppings in the drawer in addition to cockroaches crawling on the walls. The AA stated that it was reported approximately one (1) week ago, and that the facility had attempted to remove the dresser, but R1 refused. The ED stated that a pest control treatment was scheduled for 01/06/2026 when R1 was at a doctor’s appointment; however, R1 did not make the appointment. A follow up appointment was scheduled for 01/12/2026. During the visit, the LPA spoke with R1’s family member who expressed concerns and agreed to have the dresser removed.

Interview with staff revealed that one (1) staff confirmed observing cockroaches in R1’s room and three (3) other staff confirmed observing cockroaches in the hallways in addition to receiving resident reports of cockroaches in their rooms. Staff showed knowledge of reporting pest concerns to maintenance who in turn respond by treating the resident rooms with a spray that does not put residents at risk.

Based on interviews and observation, the preponderance of evidence standard has been met, therefore the allegation is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code, the following deficiency was cited (Refer to 9099-D).

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

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20260108161808

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/12/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 01/26/2026 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	(a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement was not met as evidence by:	1 2 3 4 5 6 7	The facility removed the dresser during the visit and will send proof of complete pest control treatment by POC due date.
	8 9 10 11 12 13 14	Based on interview and observation, the Licensee did not comply with the above cited section in R1 had cockroaches in their room which poses a potential health, safety, and personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2026

LIC9099 (FAS) - (06/04)

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