361800147-2-23-2024-56-AS-NBRN-D2TPXB-20240226104203

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800147
Report Date: 02/23/2024
Date Signed: 02/23/2024 12:23:49 PM

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
12/08/2023 and conducted by Evaluator Amber Coleman

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20231208164611

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:	02/23/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Araceli Soto, Care Coordinator & Gwen Galvan, Admin. Staff		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff poses a risk to residents in care.
Staff are not providing a safe environment to residents in care.
Illegal Eviction

INVESTIGATION FINDINGS:

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Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Montclair Royale Senior Living facility to deliver findings of the complaint investigation into the allegations listed above. LPA met with Care Coordinator, Araceli Soto. During the investigation, LPA met with staff and residents for interviews and collected pertinent documents for record reviews.

It is alleged that staff poses a risk to residents in care. During staff interviews it was revealed that R1 would not allow staff to provide him with services. R1 would not allow staff inside his room to provide assistance. LPA made observations of R1's room door - posted to the room door were hand written signs advising staff not to enter the room. Additionally, LPA observed staff's attempts to deliver and provide meals to R1. Meals delivered to R1's room sat on a bench untouched. According to recent Special Incident Reports, (SIR) R1 physically prevented staff from entering the room. Even when only checking in for safety. LPA made attempts to reach R1 for an interview with no success. Witness interviews are consistent with staff interviews, R1 is reported to be confrontational and not allow anyone entry to the room.

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: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

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-20231208164611

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: 02/23/2024

NARRATIVE

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It is alleged that, staff are not providing a safe environment to residents in care. LPA completed a walk through of the facility and made no observations of imminent dangers or health risks to the residents in care. R1's file contained all current and updated documentation per regulation. LPA was not able to meet with R1 to ask about the concerns R1 had for his safety at the facility. Staff interviews indicated R1 would not allow staff to enter R1's room; even for purposes of ensuring safety. When Staff attempted to enter the room or have any interaction with R1, staff was met with verbal and physical confrontation. A review of the SIR's supported this information.

It is alleged that R1 is being illegally evicted from the facility. LPA reviewed the issued eviction documentation provided to R1, Special Incident Reports and Warnings provided to R1 before the eviction was officially issued. All documentation reviewed was correctly completed per regulation for evictions. R1 was being evicted for non-compliance of facility house rules. According to Administrator, AnnaMarie Santos-Tabila, at this time, R1 is illegally detaining the room. The set eviction date has come and gone. R1 and Facility management are working to settle the matter in court. LPA was unable to reach R1 for interview, evidence, statements or documentation that would support the facility was attempting to commit an illegal eviction.

Based on interviews, record reviews and observations, 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. This report was reviewed, discussed, then provided to the facility representative.

SUPERVISOR'S NAME: Nedra Brown	TELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber Coleman	TELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:	DATE: 02/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2024

LIC9099 (FAS) - (06/04)

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