331881033-1-12-2023-56-AS-KCLS-CNELWL-20230125080720

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331881033
Report Date: 01/12/2023
Date Signed: 01/12/2023 04:21:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/09/2023 and conducted by Evaluator Javier Prieto

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230109125239

FACILITY NAME:	ROYALTY SENIOR LIVING		FACILITY NUMBER:	331881033
ADMINISTRATOR:	RILEY, TA'NEISHA		FACILITY TYPE:	740
ADDRESS:	10104 KINGS CT		TELEPHONE:	(951) 416-1064
CITY:	JURUPA VALLEY	STATE: CA	ZIP CODE:	92509
CAPACITY:	6	CENSUS: 6	DATE:	01/12/2023
		UNANNOUNCED	TIME BEGAN:	12:30 PM
MET WITH:	Ta'Neisha Riley, Administrator		TIME COMPLETED:	01:50 PM

ALLEGATION(S):

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Residents door locks poses as a risk while in care

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to initiate a complaint investigation regarding the above-mentioned allegation. LPA Prieto met with administrator Ta'Neisha Riley and toured facility to address resident door locks. MS Riley demonstrated, to LPA Prieto, how doors are opened and found to be operational and function properly. LPA interviewed client (C1) in question, who stated when the door to the bedroom is locked, it is done so by her own accord for privacy and also states the staff can request entry and staff is able to do so by easily unlocking the door with a staff key.

Based on the information obtained there is not enough evidence that the resident's door locks poses a risk while in case. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Javier Prieto	TELEPHONE: 951-217-3135
LICENSING EVALUATOR SIGNATURE:	DATE: 01/12/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/12/2023

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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