361800147-10-25-2024-56-AS-KCLS-DB9SJH-20241122125507

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800147
Report Date: 10/25/2024
Date Signed: 10/25/2024 11:49:20 AM

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
10/18/2024 and conducted by Evaluator Eldin Serrano

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20241018154624

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: 133	DATE:	10/25/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Araceli Soto, Resident Care Coordinator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff do not keep medications safe and locked

INVESTIGATION FINDINGS:

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On 10/25/2024 at 9:30 AM, Licensing Program Analysts (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegation. LPA Serrano explained the purpose of the visit to the Resident Care Coordinator Araceli Soto.

The investigation was conducted by LPA Serrano. The investigation consisted of records review, observation and interviews with relevant parties. The allegation indicates facility staff do not keep medications safe and locked. During the investigation, LPA did not find evidence to corroborate the allegation. Interviews with the Medtech Supervisor Juana Macias stated that all medication carts are locked all the time before the medtech staff go out of the medtech room to pass out medication to residents. The opened cart in particular with this allegation is just a supply cart for residents that do self administered insulin medication.

*** Continuation in LIC9099C ***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Eldin Serrano	TELEPHONE: 951-248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

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-20241018154624

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: 10/25/2024

NARRATIVE

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No medication is in that cart that was found open and not locked. Based on observation the Medtech room and medtech carts are always locked. If the residents need the insulin the medtech will hand them over the insulin from the refrigerator from the medtech room for them to administer themselves. Interviews with residents also indicated that the supply drawer is only for insulin residents and no actual medication is in that drawer/cart.

Based on the evidence, the allegation that Facility staff do not keep medications safe and locked is 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 Resident Care Director Araceli Soto.

SUPERVISOR'S NAME: Karen Clemons	TELEPHONE: (951) 836-2784
LICENSING EVALUATOR NAME: Eldin Serrano	TELEPHONE: 951-248-0351
LICENSING EVALUATOR SIGNATURE:	DATE: 10/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/25/2024

LIC9099 (FAS) - (06/04)

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