347003623-5-9-2023-27-AS-CACL-CRPUPX-20230510154615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347003623
Report Date: 05/05/2023
Date Signed: 05/09/2023 08:22:06 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/02/2023 and conducted by Evaluator Kevin Gould

COMPLAINT CONTROL NUMBER: 27-AS-20230502165008

FACILITY NAME:	ROYAL GARDENS ELDER CARE		FACILITY NUMBER:	347003623
ADMINISTRATOR:	DIZON, SHIRLEY V.		FACILITY TYPE:	740
ADDRESS:	10812 GLENHAVEN WAY		TELEPHONE:	(916) 631-7720
CITY:	RANCHO CORDOVA	STATE: CA	ZIP CODE:	95670
CAPACITY:	6	CENSUS: 3	DATE:	05/05/2023
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Joey Sayas		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Personal Rights:
1) Facility staff are not answering the facility phone
2) Facility staff are not ensuring resident receives notification of calls from family/friends.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kevin Gould made an unannounced inspection to the Royal Gardens Elder Care (RCFE) on 5/5/23 at 1:00pm to conclude the investigation of the above allegations and to deliver the findings. LPA met with staff and together discussed the investigation details.

Based on the interviews and statements obtained during the investigation process, the allegations cannot be substantiated because former resident's family members all denied the allegations. LPA was able to contact the former resident's social worker who denied the allegations and stated the facility was fantastic at communicating with the former resident's family and other authorized representatives. LPA also contacted the former resident's brother and son who both denied the allegations and stated they were able to contact the facility and the staff were supportive and communicative with family regarding former resident's care. LPA Gould was unable to contact the reporting party as the complaint was anonymous.

Report Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

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 27-AS-20230502165008

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: ROYAL GARDENS ELDER CARE	FACILITY NUMBER: 347003623
	VISIT DATE: 05/05/2023

NARRATIVE

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Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has determined that the allegations of Personal Rights are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed.

There are no deficiencies noted or cited per California Code Regulation, TITLE 22.

Exit interview was conducted with the facility staff. Appeal Rights were issued, and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Czarrina A Camilon-Lee	TELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin Gould	TELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 05/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2023

LIC9099 (FAS) - (06/04)

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