361800147-9-29-2020-18-AS-RLAY-BU6V46-20201007160546

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800147
Report Date: 09/21/2020
Date Signed: 09/29/2020 11:45:44 AM

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
RIVERSIDE, CA 92507

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/24/2020 and conducted by Evaluator Pauline Beschorner

COMPLAINT CONTROL NUMBER: 18-AS-20200624093607

FACILITY NAME:	MONTCLAIR ROYALE SENIOR LIVING		FACILITY NUMBER:	361800147
ADMINISTRATOR:	SANTOS, ANNAMARIE		FACILITY TYPE:	740
ADDRESS:	9685 MONTE VISTA AVE		TELEPHONE:	(909) 621-3545
CITY:	MONTCLAIR	STATE: CA	ZIP CODE:	91763
CAPACITY:	236	CENSUS: 128	DATE:	09/21/2020
		UNANNOUNCED	TIME BEGAN:	02:45 PM
MET WITH:	ARACELIE SOTO		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff is retaliating against resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pauline Beschorner conducted this investigation visit telephonically due to Covid-19 to conclude this agency’s investigation into the complaint allegations mentioned above. LPA spoke with Assistant Administrator Araceli Soto.

During this investigation, interviews were conducted with the Assistant Administrator, four staff (S1-S4) and three residents (R2-R4). The allegation states the facility staff is retaliating against resident. Interviews with Assistant Administrator, S1-S4 and R2-R4 provided conflicting information. Reporting Party (RP) feels facility staff are retaliating by harassing R1 due to calls that have been made to various agencies. Interviews with Assistant Administrator and staff deny the facility is retaliating against the resident. Interviews with residents R2-R4, reveal that the staff are very helpful, and the residents are happy with the care that is being received. R2-R4 stated that they have never felt retaliated against or seen residents being treated differently.

CONTINUED ON NEXT PAGE

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline Beschorner	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2020

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 18-AS-20200624093607

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: MONTCLAIR ROYALE SENIOR LIVING	FACILITY NUMBER: 361800147
	VISIT DATE: 09/21/2020

NARRATIVE

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Based on the information obtained there is not enough evidence that facility staff is retaliating against resident. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was reviewed, and appeal rights were provided to Assistant Administrator Araceli Soto, whose signature on this form confirm receipt of the above-mentioned documents.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline Beschorner	TELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:	DATE: 09/21/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/21/2020

LIC9099 (FAS) - (06/04)

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