565801851-10-30-2025-29-AS-DPEA-DMY7LR-20251030214559

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801851
Report Date: 10/28/2025
Date Signed: 10/30/2025 05:49:49 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/28/2025 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20250828085937

FACILITY NAME:	ROYAL OAKS HOME CARE		FACILITY NUMBER:	565801851
ADMINISTRATOR:	KAREN ROSALES		FACILITY TYPE:	740
ADDRESS:	1106 ROYAL AVENUE		TELEPHONE:	(805) 210-2757
CITY:	SIMI VALLEY	STATE: CA	ZIP CODE:	93065
CAPACITY:	6	CENSUS: 6	DATE:	10/28/2025
		UNANNOUNCED	TIME BEGAN:	04:15 PM
MET WITH:	Karina Antig		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

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Staff did not pick up resident’s medication prescription in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a subsequent complaint visit to the facility. The purpose of the visit is to deliver investigation findings. Upon arrival LPA met with staff and staff contacted Administrator who arrived shortly after LPA. Entrance interview conducted.

On 8/28/2025, the Department received a complaint with the above allegation. Information was received that resident #1 (R1) missed three doses of prescription pain medication due to staff refusing to pick it up from the pharmacy. It was alleged that the Administrator of the facility refused to pick up medication stating that she is "busy". In addition, staff also refused to pick up R1’s medications.

Initial onsite visit was conducted on 09/05/2025, LPA conducted a physical plant tour with staff at approximately 11am. LPA interviewed four (4) out five (5) residents; reviewed medication records with administrator and interviewed two (2) staff from approximately 11:30am-12:45pm. LPA also discussed the allegation with Administrator. (Continue to LIC9099c).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025

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 29-AS-20250828085937

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROYAL OAKS HOME CARE	FACILITY NUMBER: 565801851
	VISIT DATE: 10/28/2025

NARRATIVE

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Interview conducted with Administrator indicates that R1 is self responsible; R1 is on several medications including pain medication (oxycodone). This pain medication requires a physician order for prescription to be filled by the pharmacy which R1 obtained on 08/20/2025. According to Administrator she received a text message sent by R1 which was shared with LPA, that the pain medication was ordered, and prescription was sent to Walgreens pharmacy. On 08/20/2025, Administrator went to pick medication at 12pm and the pharmacy did not have the medication ready; administrator returned at 1pm and it was still not ready, and administrator was informed that the prescription should be ready by 4pm. Administrator stated she returned at 4pm and she still had to wait at least 40min to get the medication. According to Administrator R1 was provided with the morning dose on 08/20/2025 and received the noon dose later in the evening as a result of the medication not being filled by Walgreens until after 4:30pm on 08/20/2025. Review of R1’s medication records confirmed that the paint medication was provided on 08/20/2025. Facility staff interviewed indicated that at no time did R1 go without medications. Medications reviewed during facility visits revealed that the medications were documented accordingly and administered as prescribed, on both the centrally stored medication record and the MAR for the last three months (08/2025; 07/2025 and 06/2025). R1 confirmed receiving the pain medication on 08/20/2025; R1 reported that the noon dose was given in the evening therefore R1 took another later before going to bed.

Based on interview and record review, although the allegation may be valid, at this time there is insufficient evidence to support the allegation, therefore, the allegation that "Staff did not pick up resident’s medication prescription in a timely manner" is deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted. A copy of the report was provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Zabel Chochian
LICENSING EVALUATOR SIGNATURE:	DATE: 10/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2025

LIC9099 (FAS) - (06/04)

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