306003567-3-7-2023-22-AS-SSAS-CPR3YS-20230308174022

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306003567
Report Date: 03/07/2023
Date Signed: 03/07/2023 03:19:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/01/2023 and conducted by Evaluator Kevin Saborit-Guasch

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230301140104

FACILITY NAME:	STATE ROYALE GUEST HOME		FACILITY NUMBER:	306003567
ADMINISTRATOR:	LEILANI ALEJANDRO		FACILITY TYPE:	735
ADDRESS:	840 STATE COLLEGE BLVD., S.		TELEPHONE:	(714) 563-2392
CITY:	ANAHEIM	STATE: CA	ZIP CODE:	92806
CAPACITY:	6	CENSUS: 5	DATE:	03/07/2023
		UNANNOUNCED	TIME BEGAN:	01:31 PM
MET WITH:	Leilani Alejandro, Administrator May Dumlao, Assistant administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility P& I ledgers are not accurate for the clients

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch conducted an unannounced visit for the purpose of investigating the allegation listed above. LPA arrived at facility, rang the bell and knocked but did not get a response. A call was made to administrator Leilani Alejandro who informed staff of the presence of licensing staff. LPA was then greeted and granted entry into the facility after stating the purpose of the visit.

While LPA toured the facility with caregiver. LPA requested, obtained and reviewed the facility ledgers for clients C1 and C2. Records of accounts of cash resources, personal property, and valuables entrusted to the licensee are observed to be accurate and complete with both receipts for cash provided inclusive of all required information and receipts for every purchase marked on the ledger. Some purchases are however not marked in chronological order. A Technical Assistance Advisory note was provided to the licensee on that topic.

CONTINUED ON FORM LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

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 22-AS-20230301140104

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: STATE ROYALE GUEST HOME	FACILITY NUMBER: 306003567
	VISIT DATE: 03/07/2023

NARRATIVE

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CONTINUED ON FORM LIC9099

Regarding the allegation that Facility P&I ledgers are not accurate for the clients, the following has been concluded: Based on interviews conducted and a review of the records for clients C1 and C2 conducted at the facility, records of accounts of cash resources, personal property, and valuables for both clients are observed to be accurate and documented by receipts including all necessary information per Section 80026(h) of the California Code of Regulations at the time of the visit. Licensee adds however that the payeeship vendor currently contracted had requested earlier corrections due to noted discrepancies in the documentation submitted, which have since then been addressed and corrected. The allegation is therefore found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted and a copy of this report was provided to facility representative.

SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:	DATE: 03/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2023

LIC9099 (FAS) - (06/04)

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