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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 03/10/2026
Date Signed: 03/10/2026 05:04:11 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
03/09/2026 and conducted by Evaluator Quoc Huynh
PUBLIC
COMPLAINT CONTROL NUMBER: 29-AS-20260309155141
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:
03/10/2026
UNANNOUNCEDTIME BEGAN:
12:50 PM
MET WITH:Lori McKay - Administrator
Joey Vitug - Facility Manager		TIME COMPLETED:
05:15 PM
ALLEGATION(S):
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Staff abandoned resident at hospital
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Quoc Huynh conducted an initial complaint visit for the above allegation. The LPA arrived at 12:50PM and met with Facility Manager Joey Vitug and Administrator Lori McKay. Entrance interview conducted.

Between 12:58PM and 2:06PM, the LPA conducted a physical plant tour and interviewed, the Facility Manager and Administrator, and reviewed and obtained pertinent documents. The following was then determined:

Allegation: “Staff abandoned resident at hospital”

It was reported that the facility refused to accept Resident #1 (R1) back from the hospital. On 02/27/2026, R1 was transferred to the hospital due to constipation. Upon R1’s discharge, the facility informed the hospital that R1 required a higher level of care and could not be re-admitted.

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

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
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 29-AS-20260309155141
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: 03/10/2026
NARRATIVE
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Interview with the Facility Manager revealed that the facility believed R1 required a higher level of care due to a diagnosis of incomplete quadriplegia and frequent hospital visits for disimpaction. The Facility Manager stated that R1 required extensive care and acknowledged that a re-appraisal had not been completed. The Facility Manager also reported that prior to the 02/27/2026 hospital transfer, R1 had expressed interest in relocating to a Skilled Nursing Facility (SNF), and that R1’s provider and the Long-Term Care Ombudsman (LTCO) agreed that a higher level of care was appropriate. The Facility Manager further stated that R1’s provider informed the hospital that R1’s safety would be at risk if discharged back to the facility. R1 was later transferred to a second hospital, which also contacted the facility to arrange R1’s return; the facility again refused readmission. Interview with the Administrator revealed that the facility believed R1’s disruptive behaviors, need for a two (2) person assist, and assistance with smoking were beyond what the facility could provide. The Facility Manager and Administrator stated that the facility attempted to relocate R1 to other licensed facilities and SNFs but was unsuccessful.

Record review confirmed that the facility did not document a change of condition, did not complete a re-appraisal, and did not provide evidence that R1’s needs exceeded the facility’s licensed capacity. Information provided by the hospital indicated that R1 was medically cleared for discharge back to the facility and that R1 was in agreement with returning.

Based on interviews and record review, the facility initiated the refusal of readmission despite the hospitals’ attempts to discharge R1 and R1’s expressed desire to return. The preponderance of evidence standard has been met; therefore, the allegation is deemed SUBSTANTIATED at this time.

Pursuant to Title 22 CA Code of Regulations and/or the Health and Safety Code, the following deficiency was cited (Refer to LIC 9099-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: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20260309155141
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: 03/10/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/11/2026
Section Cited
CCR
87468.2(a)(20)
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(a) In addition to the rights listed in Section 87468.1... residents... shall have all of the following personal rights: (20) To be protected from involuntary transfers, discharges, and evictions...

This requirement was not met as evidenced by:
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The Licensee will re-admit R1 to the facility from the hospital and send proof to CCLD by POC due date.
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Based on interview and record review the Licensee did not comply with the section cited above in the facility refused R1's readmission upon hospital discharge which poses/posed an immediate health, safety, and personal rights 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: Kristin Heffernan
LICENSING EVALUATOR NAME: Quoc Huynh
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
LIC9099 (FAS) - (06/04)
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