361800147-2-9-2026-56-AS-KCLS-DRH38Y-20260220170220

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 361800147
Report Date: 02/09/2026
Date Signed: 02/09/2026 09:55:32 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
01/13/2026 and conducted by Evaluator Eldin Serrano

PUBLIC

COMPLAINT CONTROL NUMBER: 56-AS-20260113154442

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: 122	DATE:	02/09/2026
		UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	Araceli Soto, Care Coordinator		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff do not distribute residents' medications as prescribed
Staff confine resident to wheelchair
Staff do not maintain facility in good repair
Staff do not follow proper medication management protocol

INVESTIGATION FINDINGS:

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On 2/09/2026 at 8:55 AM, 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 distribute residents' medications as prescribed – Interviews with staff and residents confirmed that medications are administered according to prescription. Staff place medications in a serving cup, provide them to the residents, and observe the resident taking them with water. There was no evidence that staff used a deceased resident’s medication for another resident, even when prescriptions were identical. LPA was unable to substantiate the allegation.

******continuation on LIC9099C*****

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026

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-20260113154442

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: 02/09/2026

NARRATIVE

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Allegation #2: Staff confine resident to wheelchair – Based on LPA’s observation, resident #1 (R1) was not restrained and did not have a gait belt that could confine R1 to the wheelchair. Interviews with residents and staff confirmed that no residents were confined to wheelchairs by staff. Therefore, the allegation could not be substantiated.

Allegation #3: Staff do not maintain facility in good repair – Based on LPA observation, it was confirmed that the exit door near room 309 is in good repair. There was no indication that the exit door was ever broken or replaced. LPA was unable to corroborate the allegation.

Allegation #4: Staff do not follow proper medication management protocol – Staff interviews confirmed that only the administrator or care/nurse coordinator are authorized to destroy narcotics. MedTech staff prepare the required documentation and transfer the medication to the administrator or care coordinator for disposal. For non-narcotic medications, two MedTech staff must jointly dispose of them in a designated container, which the pharmacy collects when full. LPA observed that the medication carts are always locked and need a key to access them. The LPA was unable to substantiate 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 and LIC9099C were discussed and provided to Care Coordinator Araceli Soto.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Eldin Serrano
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2026

LIC9099 (FAS) - (06/04)

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