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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881033
Report Date: 07/13/2026
Date Signed: 07/13/2026 11:19:30 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/11/2026 and conducted by Evaluator Beena Singh
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20260311135217
FACILITY NAME:ROYALTY SENIOR LIVINGFACILITY NUMBER:
331881033
ADMINISTRATOR:RILEY, TA'NEISHAFACILITY TYPE:
740
ADDRESS:10104 KINGS CTTELEPHONE:
(951) 416-1064
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
92509
CAPACITY:6CENSUS: 3DATE:
07/13/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Facility Staff Administrator Shana WilliamsTIME COMPLETED:
11:30 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not meet residents hygiene care needs.
Facility is not releasing medical information to residents responsible person.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Beena Singh arrived to the facility to conclude a complaint investigation regarding the above allegations. LPA Beena Singh met with Tricia Zendejas, Caregiver, and was granted entry to the facility.
During the visit there were two staff and three residents present. LPA Singh conducted a walk through of the facility. Facility Staff Administrator Shana Williams arrived during the visit and LPA Singh explained the elements of the complaint.
First Allegation:-Staff did not meet residents hygiene care needs.
During the interviews conducted by LPA Singh with facility residents and staff, Resident #1 (R#1) reported being completely independent with their activities of daily living (ADLs). They specified that they manage all personal hygiene needs autonomously, requiring no assistance from staff for hair care or showering Furthermore, R#1 stated that they have been well looked after by the facility staff and expressed having no issues with their care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
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 56-AS-20260311135217
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ROYALTY SENIOR LIVING
FACILITY NUMBER: 331881033
VISIT DATE: 07/13/2026
NARRATIVE
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Second Allegation:-Facility is not releasing medical information to residents responsible person.
During an in-person interview with Licensing Program Analyst (LPA) Singh, Resident #1 stated that facility staff consistently keep their family and responsible party fully informed regarding all medical appointments. Furthermore, the resident#1 and staff emphasized that the staff routinely provide any necessary information and updates to their family members and responsible party, ensuring they remain completely aware of the resident's medical care and schedules.



Based on the evidence found during the investigation, the allegations listed above Staff did not meet residents hygiene care needs and Facility is not releasing medical information to residents responsible person are deemed
UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the
allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged
violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the
California Code of Regulations.

An exit interview was conducted with Facility Staff Administrator Shana Williams, and a copy of this report
was provided at the conclusion of the visit
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Beena Singh
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2