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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800147
Report Date: 07/24/2023
Date Signed: 07/26/2023 03:04:54 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
04/12/2023 and conducted by Evaluator Anna Bueno
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20230412140600
FACILITY NAME:MONTCLAIR ROYALE SENIOR LIVINGFACILITY NUMBER:
361800147
ADMINISTRATOR:SANTOS, ANNAMARIEFACILITY TYPE:
740
ADDRESS:9685 MONTE VISTA AVETELEPHONE:
(909) 621-3545
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY:236CENSUS: 124DATE:
07/24/2023
UNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Annamarie SantosTIME COMPLETED:
04:09 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff threatens resident in care.
Staff does not provide resident's clean clothing.
Facility washer/dryer is in disrepair.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced subsequent visit to the facility to continue the complaint investigation and deliver findings on the above allegation. LPA met with assistant care coordinator Gwen Galvan who was informed of the purpose of today’s visit. Administrator Annamarie Santos arrived during the visit. The investigation consisted of staff interviews, LPA observations, and records review. LPA was not able to interview Resident 1 (R1).

Allegation 1: Staff threatens R1 in care. It is alleged that R1 is experiencing ongoing verbal threats. LPA reviewed records that R1 was admitted to this facility on 8/26/2022. CCL received incident reports stating that R1 was observed by staff and residents entering and leaving rooms that R1 do not occupy. Additionally, CCL visited the facility due to a report that emergency services were unable to access R1 due to clutter in their room. Staff interviews deny that they threatened R1 but rather informed them that they may be evicted for violating facility house rules. This allegation is therefore unsubstantiated
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
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 3
Control Number 56-AS-20230412140600
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
, CA 92507
FACILITY NAME: MONTCLAIR ROYALE SENIOR LIVING
FACILITY NUMBER: 361800147
VISIT DATE: 07/24/2023
NARRATIVE
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Allegation 2 and 3: Staff does not provide resident's clean clothing AND Facility washer/dryer is in disrepair. Interviews with residents and staff revealed that facility washers and or dryers would break often. LPA reviewed records and found that, of the current census 92 residents are signed up for facility laundry services, which averages to 13 services per day. LPA observed four laundry rooms in the facility, three of which had two sets of washer and dryer and one with commercial units specifically used by staff. Staff interviews revealed that residents or their authorized parties purchase residents' clothing and may bring the clothing items to be washed and cleaned at their own homes. Based on the information obtained during this investigation, the allegations are unsubstantiated.

A finding of UNSUBSTANTIATED means that 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 administrator Annamarie Santos.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Anna Bueno
LICENSING EVALUATOR SIGNATURE:

DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/24/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 3