<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 12/04/2025
Date Signed: 12/04/2025 02:57:41 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
11/07/2025 and conducted by Evaluator Quoc Huynh
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20251107125915
FACILITY NAME:RESIDENCES AT ROYAL BELLINGHAM, THEFACILITY NUMBER:
197608129
ADMINISTRATOR:ANGELITO VITUGFACILITY TYPE:
740
ADDRESS:12229 CHANDLER BOULEVARDTELEPHONE:
(818) 980-2997
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:96CENSUS: 87DATE:
12/04/2025
UNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Rizaandrea Vitug - Assistant Administrator
Angelito Vitug - Executive Director		TIME COMPLETED:
03:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not report an incident to licensing
Staff did not complete a personal property inventory for a resident in care
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Quoc Huynh conducted a subsequent complaint visit to deliver findings for the above allegations. The LPA arrived at 9:56AM and met with Assistant Administrator Rizaandrea “Riza” Vitug, Executive Director (ED) Angelito “Lito” Vitug who arrived at 11:14AM and explained the reason for the visit. Entrance interview conducted.

On 11/13/2025, LPA Huynh conducted an initial complaint visit. Between 12:40PM and 5:05PM, the LPA reviewed and obtained pertinent documents, conducted a physical plant tour, interviewed four (4) residents and four (4) staff, and attempted one (1) resident interview.

Report Continued on LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
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 8
Control Number 29-AS-20251107125915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: RESIDENCES AT ROYAL BELLINGHAM, THE
FACILITY NUMBER: 197608129
VISIT DATE: 12/04/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During today’s visit between 10:17AM and 1:35PM, the LPA conducted a physical plant tour and interviewed five (5) residents and four (4) staff. No immediate concerns were observed. The following was then determined:

Allegation: “Staff did not report an incident to licensing.”

It was reported that the facility did not notify Community Care Licensing (CCL) of an unwitnessed fall. On 07/26/2025, Resident #1 (R1) sustained an unwitnessed fall in their unit and was found on the floor by their bedside. The facility notified R1’s family and R1 was subsequently transferred to the hospital via Emergency Services. Interview with five (5) out of seven (7) staff revealed that they were unaware about the CCL reporting requirements, or if facility incidents were reported to CCL. Staff responsibilities include logging incidents in the facility’s electronic system and facility Administrators are responsible for the remaining steps. Interview with the ED noted that they “assumed Licensing received the report” of R1’s fall. When the LPA inquired about the details of the fall, the ED requested to review the copy the LPA obtained and provided information off the Incident Report.

On 11/05/2025, the LPA conducted an unrelated complaint visit and addressed facility Incident Reports with the Office Manager Joey Vitug. The Office Manager is responsible for completing Incident Reports and sending them to CCL. They stated they utilize an App called Genius Scan that scans the Incident Reports which processes and automatically emails CCL the reports.

During the visit on 11/13/2025, the LPA reviewed CCL’s record of Incident Reports received from 2024 to present with the ED, the incident on 07/26/2025 not included as it was not received. The ED expressed and confirmed that the record did not reflect the accurate number of incidents the facility has experienced. The LPA addressed the Genius Scan App and suggested that the facility email all reports to the Woodland Hills North Regional Office directly to ensure receipt and compliance. The ED agreed.

Report Continued on LIC 9099-C
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 29-AS-20251107125915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: RESIDENCES AT ROYAL BELLINGHAM, THE
FACILITY NUMBER: 197608129
VISIT DATE: 12/04/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on interviews and record review, the preponderance of evidence standard has been met, therefore the allegation is deemed SUBSTANTIATED at this time.

Allegation: “Staff did not complete a personal property inventory for a resident in care.”

It was reported that the facility did not complete a personal property inventory upon admission. Four (4) out of seven (7) staff reported the facility does not complete a personal property inventory upon resident admission and are unsure of the procedure. The ED confirmed that resident personal property inventory is only completed if the property is entrusted to the facility. The LPA reviewed Health and Safety Code Section 1569.153 Theft and Loss Program and CA Code of Regulations Section 87217 Safeguards for Resident Cash, Personal Property, and Valuables with the ED.

Record review of five (5) resident records revealed that LIC 621 Client/Resident Personal Property and Valuables form and Theft and Loss Policy were included in the resident Admission Agreement on pages “RB RF-31” to “RB RF-34.” The LIC 621 on page RB RF-31 did not list the residents’ names and included typed notes stating “I have no property/valuables entrusted to Royal Bellingham at this time” and “NOTE: The Residences at Royal Bellingham will only inventory and provide the resident or responsible party with a copy of the resident’s personal properties/valuables as inventoried items if said items are entrusted to the facility and are stored in a secured area controlled by the facility. Any and all other personal properties or valuables are solely the responsibility of the resident and/or their responsible party.” Health and Safety Code Sections 1569.152, 1569.153, and 1569.154 on page RB RF-32 did not contain signatures of receipt. The facility’s Theft and Loss Policy on page RB RF-33 noted “The Administrator will be responsible for maintaining a record of each Resident’s personal property/valuables. Resident’s Personal Property and Valuables (Form 621) will be completed upon admission with the assistance of the Resident or Responsible Party” and “An inventory of personal property will be maintained by The Royal Bellingham.” Six (6) out of nine (9) residents confirmed a personal property/valuables inventory was not completed upon admission.

Report Continued on LIC 9099-C
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 29-AS-20251107125915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: RESIDENCES AT ROYAL BELLINGHAM, THE
FACILITY NUMBER: 197608129
VISIT DATE: 12/04/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on interviews and record review, the preponderance of evidence standard has been met, therefore the allegation is deemed SUBSTANTIATED at this time.

Pursuant to Title 22, California Code of Regulations and/or CA Health and Safety Code, the following deficiencies were cited (Refer to LIC9099-D).

Exit interview conducted. A copy of the appeal rights and report was reviewed and provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 29-AS-20251107125915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: RESIDENCES AT ROYAL BELLINGHAM, THE
FACILITY NUMBER: 197608129
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/18/2025
Section Cited
CCR
87211(a)(1)
1
2
3
4
5
6
7
(a) Each licensee shall furnish to the licensing agency such reports…including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency… within seven days of the occurrence of any of the events specified in (A) through (D) …

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Licensee plans to continue utilizing Genuis App in addition to emailing CCL incident reports. An in-service staff training will also be conducted on CCL reporting requirements and will be provided to CCLD by the POC due date.
8
9
10
11
12
13
14
Based on interview and record review the Licensee did not comply with the above cited section as CCL did not receive a report/notification of an unwitnessed fall which poses a potential health, safety, or personal rights risk to persons in care.
8
9
10
11
12
13
14
Type B
12/18/2025
Section Cited
HSC
1569.153(d)
1
2
3
4
5
6
7
(d) A written resident personal property inventory is established upon admission and retained during the resident's stay in the residential care facility for the elderly. Inventories shall be written in ink, witnessed by the facility and the resident or resident's representative, and dated. …

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Licensee removed the disclaimer from LIC 621 and will inventory resident belongings upon admission. An in-service staff training will also be conducted on admisison precedures and will be provided to CCLD by the POC due date.
8
9
10
11
12
13
14
Based on interview and record review the Licensee did not comply with above cited section in the facility did not complete a personal property inventory written in ink upon admission which poses a potential health, safety, or personal rights risk to persons in care.
8
9
10
11
12
13
14
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: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
11/07/2025 and conducted by Evaluator Quoc Huynh
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20251107125915

FACILITY NAME:RESIDENCES AT ROYAL BELLINGHAM, THEFACILITY NUMBER:
197608129
ADMINISTRATOR:ANGELITO VITUGFACILITY TYPE:
740
ADDRESS:12229 CHANDLER BOULEVARDTELEPHONE:
(818) 980-2997
CITY:VALLEY VILLAGESTATE: CAZIP CODE:
91607
CAPACITY:96CENSUS: 87DATE:
12/04/2025
UNANNOUNCEDTIME BEGAN:
09:56 AM
MET WITH:Rizaandrea Vitug - Assistant Administrator
Angelito Vitug - Executive Director		TIME COMPLETED:
03:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent a resident from being locked outside for a long period of time
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Quoc Huynh conducted a subsequent complaint visit to deliver findings for the above allegation. The LPA arrived at 9:56AM and met with Assistant Administrator Rizaandrea “Riza” Vitug, Executive Director (ED) Angelito “Lito” Vitug who arrived at 11:14AM and explained the reason for the visit. Entrance interview conducted.

On 11/13/2025, LPA Huynh conducted an initial complaint visit. Between 12:40PM and 5:05PM, the LPA reviewed and obtained pertinent documents, conducted a physical plant tour, interviewed four (4) residents and four (4) staff, and attempted one (1) resident interview.

Report Continued on LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 29-AS-20251107125915
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: RESIDENCES AT ROYAL BELLINGHAM, THE
FACILITY NUMBER: 197608129
VISIT DATE: 12/04/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During today’s visit between 10:17AM and 1:35PM, the LPA conducted a physical plant tour and interviewed five (5) residents and four (4) staff. No immediate concerns were observed. The following was then determined:

Allegation: “Staff did not prevent a resident from being locked outside for a long period of time”

It was reported that on 11/02/2025 around 8:30PM, Resident #1 (R1) returned to the facility and was locked outside for approximately twenty-five (25) minutes. Interview with nine (9) residents revealed that they have not experienced, or observed other residents locked outside. Eight (8) staff reported residents waiting a maximum of ten (10) minutes and noted that response time is typically very quick when visitors and residents return to the facility late at night. The facility locks the exterior doors in the late evening, and visitors can utilize the doorbell/buzzer and call the facility phone number to gain entrance. Staff reported the doorbell to be heard easily in the night due to most residents resting and the facility being quiet. Additionally, staff carry a wireless phone which receives all phone calls made to the facility.

Doorbell footage of the rear entrance on 11/02/2025 revealed that R1 approached the door at 8:42PM. R1’s family rang the doorbell at 8:43PM and was observed to subsequently ring the doorbell several times before attempting to call the facility phone number. At 8:47PM, Staff opened the rear door while R1 and their family entered the facility. R1 was at the rear entrance for approximately five (5) minutes before gaining entry.

Although the allegation may have happened or are valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed UNSUBSTANTIATED at this time.

No deficiency cited. Exit interview conducted. A copy of today’s report was reviewed and provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 12/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/04/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 8