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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005936
Report Date: 12/20/2022
Date Signed: 12/20/2022 04:22:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/28/2022 and conducted by Evaluator Jerome Haley
COMPLAINT CONTROL NUMBER: 22-AS-20221128131020
FACILITY NAME:ROYALIST HOME CAREFACILITY NUMBER:
306005936
ADMINISTRATOR:ASAWADILOKCHAI, YANINEEFACILITY TYPE:
740
ADDRESS:6001 ROYALIST DRIVETELEPHONE:
(714) 655-6454
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 5DATE:
12/20/2022
UNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Yaninee AsawadilokchaiTIME COMPLETED:
04:40 PM
ALLEGATION(S):
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Licensee allowed unfingerprinted adults to live in the facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to this facility to deliver findings on the complaint 22-AS-20221128131020.
LPA Haley was granted entry by staff explained the reason for the visit.
Regarding the allegation: Licensee allowed unfingerprinted adults to live in the facility
The initial complaint visit, to initiate the investigation into the complaint allegation above was conducted December 1, 2022. Through interviews with the licensee, staff, residents, and document review revealed the following:
An unlicensed boyfriend has been allowed to stay at the facility overnight on more than one occasion. This information was confirmed by more than one person during the interviews conducted December 1, 2022. Furthermore. LPA received a copy of an LIC 9163 (Request for Live Scan Service) that was submitted for the boyfriend dated 8.3.22. On the LIC 9163 the Home Address listed for the “boyfriend” matches the address for Royalist Home Care (6001 Royalist Dr Huntington Beach CA 92647).
Continued on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
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 3
Control Number 22-AS-20221128131020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ROYALIST HOME CARE
FACILITY NUMBER: 306005936
VISIT DATE: 12/20/2022
NARRATIVE
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Based on the evidence gathered, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. Violations are being cited per California Code of Regulations Title 22, Division 6, Chapter 1.

An exit interview was conducted and a copy of this report, LIC 9099D, and appeal rights were provided to licensee Yaninee Asawadilokchai.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20221128131020
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ROYALIST HOME CARE
FACILITY NUMBER: 306005936
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/20/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/20/2022
Section Cited
CCR
87355(e)(1)(2)
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87355(e)(1)(2) Criminal Record Clearance-All individuals subject to a criminal record review shall obtain a California clearance or a criminal record exemption as required by the Department or request a transfer of a criminal record clearance as specified in Section 87355 prior to working, residing or volunteering in a licensed facility.
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Licensee/Administrator agrees to fingerprint all staff and non-residents before working or residing in the facility. Proof of understanding will be provided by 12/23/22.

Civil penalties assessed
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This requirement was not met as evidenced by:

Licensee allowed "boyfriend" to stay in the facility overnight without a fingerprint clearance. This poses an immediate health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 12/20/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3