361800147-10-16-2023-56-AS-NBRN-CWRVJL-20231019162856

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800147
Report Date: 10/16/2023
Date Signed: 10/16/2023 10:48:10 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 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
05/03/2023 and conducted by Evaluator Amber Coleman

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20230503082338

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: 125	DATE:	10/16/2023
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Araceli Soto, Care Coordinator		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Staff does not ensure resident has access to resident's wheelchair.
Staff does not ensure resident's room is clean and sanitary.
Staff does not ensure resident's call light works.

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Amber Coleman, (LPA) made an unannounced visit to the Monclair Royale Senior Living Facility to deliver the findings of the complaint investigation. LPA met with Care Coordinator, Araceli Soto and stated the purpose of the visit. The investigation included interviews with staff and residents, a review of records and observations.

It is alleged that staff does not ensure the resident has access to the resident’s wheelchair. Staff interviews revealed that R3’s wheelchair is kept in R3’s closet for the purposes of safety. During LPA’s visit, LPA made observation of R3’s room. LPA observed the wheelchair inside of the room outside of the closet. LPA accessed the wheelchair, opened it, pushed it, opened the foot pedals. The wheelchair appeared to be functional and in good repair. All staff report R3 has the ability to walk on their own on the floor. Photographic evidence depicted a wheelchair next to the resident’s bed, giving the resident access to the wheelchair.
**Please see LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2023

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 56-AS-20230503082338

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: MONTCLAIR ROYALE SENIOR LIVING	FACILITY NUMBER: 361800147
	VISIT DATE: 10/16/2023

NARRATIVE

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It is alleged that staff do not ensure the residents’ room is clean and sanitary. During interviews with housekeeping staff, it was discovered that resident rooms are cleaned several times a week. For some residents this service is optional, while other residents’ rooms are routinely cleaned. During a visit to the facility, LPA observed a refrigerator with concerns for cleanliness, a water-stained ceiling tile. LPA also observed and later confirmed that R3 does not utilize the refrigerator in the room. The stained ceiling tile was replaced. All matters of concern were addressed at the time of the visit.

It is alleged that staff do not ensure the resident’s call light works. During staff interviews and observations, LPA learned that when the call light is pulled, it notifies the staff in the office. Each time this occurs, office staff document when the call light was pulled, what room and what staff responded. LPA reviewed call light response logs for 5/4/23 through 5/8/23. No entry in the log indicated that a call light in the resident’s room was triggered. According to the facility’s maintenance logs, there is no indication that the call light is not functional.

Based on information above, these allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means 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.

An exit interview was conducted with facility representative; this report was reviewed, discussed then provided.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 10/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2023

LIC9099 (FAS) - (06/04)

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