198602564-7-21-2026-28-AS-DSIS-DX2VDP-20260817162105

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602564
Report Date: 07/21/2026
Date Signed: 07/21/2026 02:44:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/18/2026 and conducted by Evaluator Christian Gutierrez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20260618093053

FACILITY NAME:	ROYAL VISTA SAN GABRIEL		FACILITY NUMBER:	198602564
ADMINISTRATOR:	SARAH RAFAEL		FACILITY TYPE:	740
ADDRESS:	901 W SANTA ANITA ST		TELEPHONE:	(626) 289-8889
CITY:	SAN GABRIEL	STATE: CA	ZIP CODE:	91776
CAPACITY:	100	CENSUS: 20	DATE:	07/21/2026
		UNANNOUNCED	TIME BEGAN:	09:42 AM
MET WITH:	Ghea Guzman		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff overmedicated resident.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Christian Gutierrez conducted an unannounced subsequent complaint investigation visit regarding above allegations. LPA met with Assistant Clinical Administrator Ghea Guzman and explained the reason for the visit.

The investigation consisted of the following: During the initial visit on 06/19/26 LPA requested a copy of resident roster and staff roster. LPA interviewed Administrator and staff 1(S1). LPA obtained the following documents: R1’s face sheet, active medication list, MD notes, request order for hospice care, medical assessment LIC 602, admission record for St. Vincent dated 06/13/26, and SIR report dated 06/10/26. During today’s visit LPA obtained medication destruction log, an updated physician report LIC 602, and caregiver notes. LPA interviewed staff #2- staff #6 (S2-S6), resident #2-residents #6 (R2-R6), phone interview with R1, W2, attempted interview with W1 and delivered findings.

SEE LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

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 2

Control Number 28-AS-20260618093053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ROYAL VISTA SAN GABRIEL	FACILITY NUMBER: 198602564
	VISIT DATE: 07/21/2026

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

In regard to the allegation “Staff overmedicated resident”, it is alleged that staff gave R1 too much medication and that R1 would be asleep for most of the day. During interviews with Administrator and staff, six (6) out of six (6) stated that resident have never been overmedicated. S1 stated that R1 ‘s health is declining and that he/she takes a lot of medication that causes sleepiness. During record review LPA obtained documents listing R1’s health conditions and a full list of medications that did include medications that would cause sleepiness. R1 also receives palliative/hospice services due to progressive decline and increasing need for comfort focused care. During interviews with residents, four (4) out of five (5) stated that they have never had any problems with medication being given by staff. R1 was unable to answer LPA’s questions. LPA interviewed W1 over the telephone and could not get a clear answer to any questions asked. W1 did not know anything about the allegation listed above.

Based on interviews conducted and records reviewed, there is insufficient evidence to support the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was given.

SUPERVISORS NAME: David Sicairos
LICENSING EVALUATOR NAME: Christian Gutierrez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 2