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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800147
Report Date: 12/17/2025
Date Signed: 12/17/2025 04:01:15 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
12/11/2025 and conducted by Evaluator Eldin Serrano
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20251211104112
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: 121DATE:
12/17/2025
UNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Araceli Soto, Care CoordinatorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff do not properly maintain the facility
Staff do not keep the facility free from scabies
Staff do not prevent the residents from being exposed to a prohibited health condition
INVESTIGATION FINDINGS:
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On 12/17/2025 at 12:55PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to investigate and deliver the findings of the above allegations. LPA Serrano met with care coordinator Araceli Soto to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation.

Allegation #1: Staff do not properly maintain the facility – Based on information received during staff and resident’s interviews, all of them stated that the staff and housekeeping clean their room every day. LPA observed staff vacuuming, shampooing and cleaning the carpet in resident rooms and in hallways. Facility also provided the housekeeping schedule. LPA was unable to corroborate the allegation.

Allegation #2: Staff do not keep the facility free from scabies - Based on interviews with residents and staff, all of them stated that they have not had any scabies cases for a while and no scabies cases lately. LPA was unable to corroborate the allegation

*** Continuation in LIC9099C ***



Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
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-20251211104112
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: 12/17/2025
NARRATIVE
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Allegation #3: Staff do not prevent the residents from being exposed to a prohibited health condition - Based on interviews and information received during the investigation 6 out of 6 staff and 8 out 8 residents stated that the facility staff take preventive measures to make sure the residents are not exposed to any prohibited health conditions. Staff stated that they used personal protective equipment (PPE) every time they attend to any sick resident to prevent spreading the disease. The facility also quarantined the resident that was sick. LPA is unable to corroborate the allegation.

Information received during investigation LPA did not find evidence to corroborate the allegations.

Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is 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, therefore the allegation is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 was discussed and provided to Care Coordinator Araceli Soto.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
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