197608129-5-18-2026-29-AS-KHEN-DUJV9L-20260529161430

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 05/18/2026
Date Signed: 05/18/2026 02:53:40 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
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: 89	DATE:	05/18/2026
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Riza Vitug - Assistant Administrator Lito Vitug - Executive Director		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not seek timely medical care for resident resulting in hospitalization on multiple occasions
Staff neglect resulted in resident sustaining a fracture due to multiple unwitnessed falls
Staff did not ensure a functioning signal system was accessible to resident
Staff did not assist resident with personal care needs in a timely manner
Staff did not ensure resident’s room was maintained in clean condition
Staff did not provide adequate laundry services to resident
Staff did not provide resident with adequate personal care supplies

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Quoc Huynh conducted a subsequent complaint visit to deliver findings for the above allegations. The LPA arrived at 10AM and met with Assistant Administrator (AA) Rizaandrea Vitug. The Executive Director (ED) Angelito “Lito” Vitug arrived at 11:10AM. Entrance interview conducted.

On 01/12/2026 LPA Huynh conducted an initial visit. Between 9:15AM and 2PM, the LPA conducted a physical plant tour, reviewed and obtained pertinent documents, and interviewed six (6) staff, one (1) family, the AA, and the ED. Between 01/14/2026 and 03/25/2026 the Department interviewed facility staff, residents, family, and obtained and reviewed medical records.

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026

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 4

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: 05/18/2026

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
26
27
28
29
30
31
32

During today’s visit, the LPA and AA conducted a physical plant tour at 10:16AM, and no immediate concerns were observed. The following was then determined:

Allegations: “Staff did not seek timely medical care for resident resulting in hospitalization on multiple occasions,” “Staff neglect resulted in resident sustaining a fracture due to multiple unwitnessed falls,” “Staff did not assist resident with personal care needs in a timely manner,” “Staff did not ensure a functioning signal system was accessible to resident,” “Staff did not ensure resident’s room was maintained in clean condition,” “Staff did not provide adequate laundry services to resident,” and “Staff did not provide resident with adequate personal care supplies”

It was reported that Resident #1 (R1) was hospitalized due to sepsis, pneumonia, and a collapsed lung and that R1 sustained multiple falls resulting in a shoulder fracture due to staff neglect. It was further reported that staff did not provide timely assistance with personal care needs in addition to providing services such as housekeeping, laundry, and personal care supplies. It was also alleged that the facility did not ensure R1’s call signal system was functioning and accessible.

Staff reported that upon admission to the facility, R1 did not require assistance; however, approximately two (2) to six (6) months prior to the allegations, R1 began needing help with showering and toileting/incontinence care. Staff stated that R1 routinely refused assistance and attempted to complete these tasks independently despite needing support. Staff reported making daily attempts to provide care, but R1 was often verbally aggressive and would not allow staff to enter their room for housekeeping, personal care, or routine checks. R1 also did not make requests for staff assistance. Staff reported that they were occasionally successful in assisting R1, but it was infrequent due to R1’s refusals. Staff did not recall the fall that resulted in a fracture and denied observing R1 with a cough or being aware of any hospitalization for sepsis, pneumonia, or a collapsed lung.

Interview with the ED supported staff’s statements regarding R1’s noncompliance. They reported that on 05/07/2024, R1 fell while showering and transported to the hospital for right shoulder and upper arm pain, where they were diagnosed with a right humerus fracture.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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: 05/18/2026

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
26
27
28
29
30
31
32

The ED stated that R1 did not want to wait for assistance and showered independently. The ED further explained that in October 2025, R1’s family requested the facility administer cough medicine; however, no physician’s order was obtained, and the facility informed the family of the requirement. The ED stated they did not observe R1 with a cough at that time. The family later transported R1 to the hospital for diarrhea. The ED additionally reported that R1 had not been hospitalized due to sepsis, pneumonia, or a collapsed lung while under the facility’s care.

Interview with R1’s Power of Attorney (POA) revealed no overall concerns with the facility or the level of care provided. They confirmed that R1 frequently refused staff assistance despite staff’s continued efforts and that the facility maintained an open line of communication regarding R1’s care. The POA visited the facility approximately every other day and stated that staff did their best to accommodate R1. They reported that R1 developed pneumonia approximately six (6) to eight (8) months prior and that the facility could not have prevented it due to R1’s medication refusals.

R1 reported that they had been living with their family for one (1) year and described facility staff as “bossy.” R1 stated that staff did not assist them and were attentive but slow. R1 was unable to recall their fall resulting in a fracture or if they had sepsis, pneumonia, and a collapsed lung.

R1’s Physician Report dated 03/04/2025 documented diagnoses of hypertension, hyperlipidemia, and dementia. R1 was ambulatory with assistance, incontinent, confused/disoriented, and required assistance with medication management, bathing, grooming, feeding, and toileting/incontinence care. Individual Service Plan (ISP) dated 11/11/2025 documented that R1 had difficulty remembering and using information, frequently impaired judgement, disruptive or aggressive behaviors, and difficulty understanding their own personal care needs. The Medication Administration Record (MAR) indicated R1 accepted medications for thirteen (13) days in October 2025, seven (7) days in November 2025, and two (2) days in December 2025.

Report Continued on LIC 9099-C

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

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: 05/18/2026

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
26
27
28
29
30
31
32

Hospital records dated 05/07/2024 indicated R1 was assessed for a non-displaced fracture of the neck of the right radius. R1 reported to hospital staff that they chose not to wait for assistance and showered independently, slipped, and fell on their arm. R1 presented with pain and a deformity of their arm and was diagnosed with an oblique right humeral fracture and discharged on 05/08/2024. Hospital records dated 10/17/2025 indicated R1 presented with a cough and chest pain. A pulmonary exam was positive for a cough, a cardiovascular exam was positive for chest pain, and a gastrointestinal exam was positive for diarrhea and melena. A chest x-ray showed clear lungs with no new or urgent problems but noted some bibasilar atelectasis, indicating partial or full collapse of lung lobes due to blocked air sacs. R1 tested positive for a clostridium difficile (C-diff) antigen (indicating the bacterium was present) negative for the toxin test (indicating no detectable toxin). Lab results showed elevated white blood cells, and R1 was prescribed antibiotics for possible pneumonia. R1 was discharged on 10/20/2025 with diagnoses of “severe sepsis due to C-diff, community acquired pneumonia ruled out, diarrhea, melena, coronary artery disease, dementia, and hypertension.”

During the initial complaint visit on 01/12/2026, LPA Huynh observed R1’s room. The room was clean, and the carpet had been recently washed. The LPA observed R1’s pull cord was not near the bed; however, the cord was functional, accessible, and extended comfortably to the bed. The ED stated that R1 refused to utilize the pull cord and did not request staff assistance. In the closet, the LPA observed clean clothes stored in bags on the floor. The ED stated that staff placed clothes on hangers, but R1 preferred to keep them in bags. In the bathroom, the LPA observed personal hygiene supplies which included hand soap, mouth wash, multiple toothbrushes and toothpaste, body wash, shampoo/conditioner, and a hairbrush.

Based on interviews, observations, and record review, although the allegations may have happened or are valid, there is insufficient evidence to prove the alleged violations did or did not occur therefore the allegations are deemed UNSUBSTANTIATED at this time.

No deficiency cited. Exit interview conducted. A copy of the report was reviewed and provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4