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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800147
Report Date: 12/16/2025
Date Signed: 12/17/2025 05:05:07 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 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
08/19/2025 and conducted by Evaluator Renese Howell-Small
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250819160849
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: 125DATE:
12/16/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Care Coordinator, Ariceli SotoTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff does not ensure facility carpet is in good repair
Staff does not ensure outside premises is in good repair
Staff does not ensure outside patio is clean
INVESTIGATION FINDINGS:
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On 12/16/2025 at 10:00AM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegations. LPA discussed the purpose of the visit with Administrator, AnnaMarie Santos. The investigation consisted of interviews, observation and record review. LPA completed a tour of the facility with Care Coordinator, Ariceli Soto.

In regards to the allegation of staff does not ensure facility carpet is in good repair:
LPA interviewed staff and residents. LPA observed staff vacuuming, shampooing and cleaning the carpet in resident rooms and in hallways. Residents stated that staff take care of the carpet. Staff stated that the facility is in the process of replacing carpet in certain areas of the facility. Based on interviews and observation, this allegation is UNSUBSTANTIATED.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
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 2
Control Number 56-AS-20250819160849
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: MONTCLAIR ROYALE SENIOR LIVING
FACILITY NUMBER: 361800147
VISIT DATE: 12/16/2025
NARRATIVE
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In regards to the allegation of staff does not ensure outside premises is in good repair:

LPA observed that there were no obstructions to outdoor passageways. The walkway was level, stable and easy to navigate. LPA observed several residents using wheeled devices navigate the area with ease. Based upon interview and observation, this allegation is UNSUBSTANTIATED.

In regards to the allegation of staff does not ensure outside patio is clean:


LPA observed the outdoor patio area to be clean, well maintained and the furniture and cushions were in good condition. Staff stated that the gardeners come every two weeks and maintenance cleans the area daily. Based upon observation and interview, this allegation is UNSUBSTANTIATED.

UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted where this report LIC9099 and LIC9099C was discussed and a copy was provided to Care Coordinator, Ariceli Soto.
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Renese Howell-Small
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2