565801851-8-13-2024-29-AS-DPEA-D8KT29-20240828142022

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565801851
Report Date: 08/13/2024
Date Signed: 08/13/2024 11:56:18 AM

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
07/17/2024 and conducted by Evaluator Martha Arroyo

COMPLAINT CONTROL NUMBER: 29-AS-20240717152528

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:	DATE:	08/13/2024
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Karina Antig		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff hit resident in care resulting in bruising.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Martha Arroyo conducted a subsequent complaint visit to the above facility. The purpose of the visit is to deliver findings for the above allegation. The initial visit was conducted on 07/18/2024 by LPA M. Arroyo. On today's visit, LPA Arroyo met with Administrator, Karina Antig. Entrance interview.

During the initial visit on 07/18/2024, LPA Arroyo conducted a plant tour at 6:38 p.m., conducted interviews with the Administrator, two (2) staff members, and five (5) residents between 5:47 p.m. and 7:12 p.m., conducted a file review at 5:20 p.m., and obtained copies of pertinent documents relevant to the investigation.

Report Continued on LIC 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

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 29-AS-20240717152528

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: 08/13/2024

NARRATIVE

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Report Continued from LIC 9099...

It was alleged that facility staff hit resident in care resulting in bruising. It was reported that Resident #1 (R1) was physically abused by Staff #1 (S1). The complainant stated that R1 was slapped on the wrist by S1 while applying lotion which resulted in a bruise and possibly a broken wrist. Record review and interviews conducted revealed that R1 gets itchy due to the medication currently prescribed. This sometimes leave a mark because R1 tries to constantly scratch. However, facility staff assist R1 is applying the lotion so that R1 does not scratch while applying it themselves. Staff stated that R1 gets lotion applied three (3) times a day to relieve the itching. Staff also added that R1 tends to make inappropriate comments to the male staff while being assisted with Activities of Daily Living (ADL’s) resulting in having two (2) staff present at all times while assisting R1. During an interview with R1, R1 was asked about the bruising on their wrist. However, R1 was unable to describe the bruising or point where the bruising was. Additional Interviews conducted with residents revealed that they had no concerns living at the facility. Residents stated that facility staff is nice and do their best to keep all the residents happy. Furthermore, residents denied facility staff being rough or aggressive with them at any time while living at the facility. Based on the information obtained during the investigation, the Department does not have sufficient evidence to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegation “facility staff hit resident in care resulting in bruising", is deemed Unsubstantiated at this time.

Exit interview conducted. A copy of the report was provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha Arroyo	TELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:	DATE: 08/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2024

LIC9099 (FAS) - (06/04)

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