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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361800147
Report Date: 10/21/2025
Date Signed: 10/21/2025 02:16:39 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
07/30/2025 and conducted by Evaluator Lavette Farlow
COMPLAINT CONTROL NUMBER: 56-AS-20250730212708
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: DATE:
10/21/2025
UNANNOUNCEDTIME BEGAN:
12:08 PM
MET WITH:Araceli Soto, Care Coordinator/LVNTIME COMPLETED:
02:25 PM
ALLEGATION(S):
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7
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9
Staff did not meet resident's toileting needs
Staff did not meet resident's grooming needs
Staff are limiting resident's water intake
INVESTIGATION FINDINGS:
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5
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7
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On 10/21/2025 at 12:08 PM, Licensing Program Analyst (LPA) LaVette Farlow made an unannounced visit to the facility to deliver the findings of the above allegations. LPA Farlow explained the purpose of the visit to the Assistant Administrator/Care Coordinator Araceli Soto. The investigation consisted of interviews with staff and residents as well as a tour of the facility. The investigation was conducted by LPA Farlow and LPA Howell-Small. The investigation consisted of interviews with relevant parties.

1 allegation : Staff did not meet resident's toileting needs. Based on residents and staff interviews, 7 out of 7 residents and 8 out of 8 staff stated that they did not hear of or observed staff not assisting residents with toileting needs. The residents stated that staff are friendly and assist them with their needs.

*** Continuation in LIC9099C ***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
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-20250730212708
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: 10/21/2025
NARRATIVE
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R5 and R6 stated that the staff are always nice and treat them well. Based on the information and interviews the allegation is UNSUBSTANTIATED.

2 allegation : Staff did not meet resident's grooming needs. Based on residents and staff interviews, 7 out of 7 residents and 8 out of 8 staff stated that they are not aware of any problems or observed staff not willing to assist residents with grooming needs. 7 out of 7 residents stated staff assist as needed, with showers, and grooming. 8 out of 8 staff reporting assisting with showers, changing of depends and assisting residents with combing of their hair. Based on the information and interviews the allegation is UNSUBSTANTIATED.

3 allegation : Staff are limiting resident's water intake. LPA conducted interviews with staff and residents. Based on residents and staff interviews it was report that the facility provide 3 meals and 3 snacks a day with a variety of drink options. The residents have an options to have water, juice, coffee, tea, and soda. S1 and S2 stated we ensure that residents are provided 3 meals a day and 3 snacks in between meals. During this time we ensure residents are hydrated. We off the residents a variety of fluids to maintain hydration. LPA's interview with residents revealed that staff provide plenty of liquid for residents in care. Based on the information and interviews the allegation is UNSUBSTANTIATED.

During the 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 allegations 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 allegations is unsubstantiated at this time.

An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Receptionist Grace Rodriguez.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2