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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604297
Report Date: 07/10/2025
Date Signed: 07/10/2025 03:10:03 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/01/2025 and conducted by Evaluator Iby Strong
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20250701112857
FACILITY NAME:ROYAL RESIDENTIAL CAREFACILITY NUMBER:
374604297
ADMINISTRATOR:PETROV, JULIANFACILITY TYPE:
735
ADDRESS:2324 WIND RIVER RDTELEPHONE:
(619) 447-2473
CITY:EL CAJONSTATE: CAZIP CODE:
92019
CAPACITY:4CENSUS: DATE:
07/10/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrators Julian Petrov and Irina TodorovaTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff did not issue medication as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Iby Strong conducted an unannounced visit to initiate a complaint investigation the above complaint allegation. LPA identified herself and discussed the purpose of the visit with Administrators Julian Petrov and Irina Todorova.

On July 1, 2025, Community Care Licensing (CCL) received a complaint alleging Staff 1 (S1) did not issue Client 1 (C1)medications as prescribed. Details of the allegation state that C1 was issued their medication plus another client’s medications simultaneously. C1’s Physician Report dated October 23, 2024, states C1 requires assistance with medication management and is legally blind.

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
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 3
Control Number 08-AS-20250701112857
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ROYAL RESIDENTIAL CARE
FACILITY NUMBER: 374604297
VISIT DATE: 07/10/2025
NARRATIVE
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Interview with Administrator revealed that on June 29, 2025, C1 was hospitalized for stroke-like symptoms. Administrator also stated that on July 1, 2025, facility recording from June 29, 2025, revealed that S1 was observed issuing C1 multiple medications and a few hours later, C1 was heard slurring speech and could not hold body upright. Statement from C1 established that C1 recalls being issued incorrect amount of medication by S1. Medical records established that C1 was diagnosed with lethargy and slurred speech could be a result of medication error as other tests were negative. S1 records reviewed revealed S1 was up to date with medication management training. After the incident, Administrator reported the incident to primary care provider, CCL and terminated S1.

Based on interviews conducted and records reviewed a preponderance of evidence exists to support the allegation. A deficiency is cited per California Code of Regulations, Title 22 (refer to the attached LIC 9099-D). An exit interview was conducted and a copy of this report, LLIC 9099-C, LIC 9099-D, and the Licensee/Appeal Rights (LIC 9058 03/22) were provided to Administrator and signature on this form confirms receipt of documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 08-AS-20250701112857
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ROYAL RESIDENTIAL CARE
FACILITY NUMBER: 374604297
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/10/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/24/2025
Section Cited
CCR
80075(b)
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80075 Health Related Services (b)Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.
This requirement was not met as in evidence:
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Administrator states that S1 has been terminated and all other staff will receive medication management training.
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Based on interviews and records reviewed the licensee did not assist C1 medication as prescribed which posed a potential safety risk to persons in care
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Iby Strong
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3