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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800147
Report Date: 05/03/2021
Date Signed: 05/04/2021 07:53:39 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
04/05/2021 and conducted by Evaluator Tricia Danielson
PUBLIC
COMPLAINT CONTROL NUMBER: 18-NP-20210405102752
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: 106DATE:
05/03/2021
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Araceli Soto, Care CoordinatorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility has scabies
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Tricia Danielson contacted the facility to conclude a complaint investigation. LPA identified herself and discussed the purpose of the call with Care Coordinator Araceli Soto. Regarding the allegation "Facility has scabies": It was alleged that residents who reside in rooms 102, 107, and 115 have scabies. Interviews conducted revealed Resident #1(R1), who resides in the memory care unit was suspected of having scabies last month but a skin scrape test was not performed to confirm such diagnosis. R1, along with all other memory care residents, as well as memory care staff were treated with Permethrin cream as a precautionary measure. R1 was also treated with oral medication. Neither R1 nor any other memory care residents reside in rooms 102, 107, or 115. For additional precautionary measures, the facility followed guidelines as outlined from the Centers for Disease Control in the care and management of scabies. To date, all precautionary scabies treatments have been completed and there are no current suspected cases. Records reviewed also indicated the facility reported the incident as required. This agency has investigated the complaint alleging "Facility has scabies". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided via email.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 836-3135
LICENSING EVALUATOR NAME: Tricia DanielsonTELEPHONE: (951) 565-7254
LICENSING EVALUATOR SIGNATURE:

DATE: 05/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/03/2021
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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