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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602564
Report Date: 03/05/2024
Date Signed: 03/05/2024 04:57:50 PM


Document Has Been Signed on 03/05/2024 04:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:ROYAL VISTA SAN GABRIELFACILITY NUMBER:
198602564
ADMINISTRATOR:NELIDA ESTRELLA ARLANTEFACILITY TYPE:
740
ADDRESS:901 W SANTA ANITA STTELEPHONE:
(626) 289-8889
CITY:SAN GABRIELSTATE: CAZIP CODE:
91776
CAPACITY:100CENSUS: 50DATE:
03/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:34 PM
MET WITH:Nelida Arlante, AdministratorTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Galarza conducted a Case Management- Incident visit to follow up on an SOC 341 Report of Suspected Dependent Elder Abuse incident report dated 3/1/2024. LPA met with Administrator Nelida Arlante. The purpose of today's visit is to check on the health & safety of residents in care and to obtain resident records.

According to SOC 341, the facility reported suspected physical abuse of a resident. It is alleged that on 2/29/2024, during the resident council meeting three (3) residents reported that staff (S1) splashed water on resident (R1's) while sitting on the toilet, and two (2) other residents reported incidents involving care misconduct by staff (S1).

On 2/29/2023, Administration staff opened an investigation. The investigation is pending. Staff (S1) was suspended on 3/1/2024, pending investigation findings.

Facility Administrator does not have access to staff files. A staff person that works at the SNF next door, provided access to staff files. Staff (S1's) Personnel Record was obtained. A technical violation was issued.

Exit interview conducted and a copy of the report was given to Administrator.

SUPERVISOR'S NAME: Lisa HicksTELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Noemi GalarzaTELEPHONE: (323) 981-3974
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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