Complaint Investigation Report

197609001-6-3-2022-31-AS-CHAS-CGFHYA-20220718063624

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

CCLD Regional Office , 21731 VENTURA BLVD., STE. 250

This is an official report of an unannounced visit/investigation of a complaint received in our office on

06/01/2022 and conducted by Evaluator Wendell Smith

COMPLAINT CONTROL NUMBER: 31-AS-20220601123035

Facility is operating beyond the terms and conditions of the license

Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegation above. LPA met with facility staff and explained the reason for this visit.

It is alleged that the facility now has thirteen residents which is three over the capacity of ten residents the facility is allowed to have. LPA conducted a physical plant tour at approximately 10:40-10:50am. LPA observed there to be seven bedrooms with thirteen residents. Upon entry to the facility staff when asked how many residents they had stated they had thirteen residents at the facility. Staff stated five residents came from facility named ROYALTY ASSISTED LIVING II, 197609666 which the owner of this facility also owns. Staff stated that ROYALTY ASSISTED LIVING II was going to close and that's why the residents were brought to this facility. Based on the information obtained through observation and interview this allegation is deemed Substantiated. Deficiency cited on LIC 9099 D. Exit Interview conducted.