197608129-7-6-2021-29-AS-DPEA-CBYQ68-20220225105305

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 07/06/2021
Date Signed: 07/06/2021 04:16:17 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
12/22/2020 and conducted by Evaluator Brian Balisi

COMPLAINT CONTROL NUMBER: 29-AS-20201222082454

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: 62	DATE:	07/06/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Lito Vitug Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility has bed bugs
Staff are not assisting residents with showers timely due to lack of staff.
Staff are not cleaning residents rooms due to lack of staff.
Staff are not administering medications timely due to lack of staffing

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Brian Balisi conducted an unannounced subsequent investigation for the allegations listed above. LPA met with Executive Director Lito Vitug and explained the reason for the visit.
During the course of the investigation, LPA conducted a physical plant tour virtually on 12/22/2020 as well as interviewed Administrator. On 4/20/2021, LPA conducted interviews with facility staff, residents and other relevant parties. LPA also gathered and reviewed facility documentation pertinent to the allegation.
In regards to the allegation that facility has bed bugs, LPA interview with (11) residents and (3) staff revealed that most have not witnessed any bed bugs while in care. LPA records review further revealed that facility is proactive in bug and pest prevention by getting the common areas and randomly chosen resident bedrooms treated monthly. LPA interview with pest control company also revealed they are unaware of the last time they treated any rooms for bed bugs at this time and the work that they do is mostly preventative. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that facility has bed bugs. Therefore, the above allegation is UNSUBSTANTIATED at this time. (Continued on 9099-C)

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: 07/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021

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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Control Number 29-AS-20201222082454

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: RESIDENCES AT ROYAL BELLINGHAM, THE	FACILITY NUMBER: 197608129
	VISIT DATE: 07/06/2021

NARRATIVE

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(Continued from 9099)

In regards to the allegation that staff are not assisting residents with showers timely due to lack of staff, LPAs interview with (13) residents revealed that most residents did not have any existing or immediate concerns with timeliness of showers. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that staff are not assisting residents with showers timely due to lack of staff. Therefore, the above allegation is UNSUBSTANTIATED at this time.

In regards to the allegation that staff are not cleaning residents room due to lack of staff. LPA interview with (13) residents revealed that most residents did not express any concerns with their room not being cleaned due to lack of staff. During the course of the investigation LPA did observe staff cleaning resident bedrooms on multiple occasions. Based on the information gathered during this and previous visits, the department does not have sufficient evidence to determine that Staff are not cleaning residents rooms due to lack of staff. Therefore, the above allegation is UNSUBSTANTIATED at this time.

In regards to staff are not administering medications timely due to lack of staffing, LPAs interview with (13) residents revealed that each resident has received their medication in a timely manner. LPA records review of (6) resident medication logs revealed that medications are observed to be maintained timely and are filled out monthly. Based on information gathered during this and previous visits, the department does not have sufficient evidence to determine that staff are not administering medications timely due to a lack of staffing. Therefore, the above allegation is UNSUBSTANTIATED at this time.

Exit interview conducted , copy of report issued and sent via email.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Brian Balisi	TELEPHONE: (818) 421-9171
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2021

LIC9099 (FAS) - (06/04)

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