197608129-3-10-2026-29-AS-KHEN-DSK5VD-20260326201722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608129
Report Date: 03/10/2026
Date Signed: 03/10/2026 05:07:02 PM

Unsubstantiated

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
01/27/2026 and conducted by Evaluator Quoc Huynh

PUBLIC

COMPLAINT CONTROL NUMBER: 29-AS-20260127152355

FACILITY NAME:	RESIDENCES AT ROYAL BELLINGHAM, THE		FACILITY NUMBER:	197608129
ADMINISTRATOR:	ANGELITO VITUG		FACILITY TYPE:	740
ADDRESS:	12229 CHANDLER BOULEVARD		TELEPHONE:	(818) 980-2997
CITY:	VALLEY VILLAGE	STATE: CA	ZIP CODE:	91607
CAPACITY:	96	CENSUS: 87	DATE:	03/10/2026
		UNANNOUNCED	TIME 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 did not provide resident with assistance in a timely manner
Staff did not treat resident with respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Quoc Huynh conducted an unannounced subsequent complaint visit to deliver findings for the above allegations. The LPA arrived at 12:50PM and met with Facility Manager Joey Vitug and Administrator Lori McKay. Entrance interview conducted.

On 02/03/2026, the LPA conducted an initial complaint visit. Between 10:03AM and 4PM, the LPA conducted a physical plant tour, reviewed and obtained pertinent documents, and interviewed four (4) residents and four (4) staff.

During today’s visit, the LPA and Administrator conducted a physical plant tour at 12:58PM and no immediate concerns were observed. The following was then determined:

Report Continued on LIC 9099-C

Unsubstantiated

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-20260127152355

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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Allegations: “Staff did not provide resident with assistance in a timely manner” and “Staff did not treat resident with respect”

It was reported that Resident #1 (R1) was left unassisted on the evening of 01/21/2026 which resulted in R1 spending the night in their wheelchair. It was also alleged that on 12/18/2025, overnight staff mocked R1 and did not provide them with assistance. Interview with R1 revealed that at approximately 6:25PM on 01/21/2026, they had dinner and asked who would be assisting them with preparing for bed. They were informed that Staff #1 (S1) would assist; however, S1 never arrived. At approximately 9:25PM, R1 called the facility phone and S1 told them they would be assisted shortly. Assistance did not occur, and when R1 called again, there was no answer. R1 remained in their wheelchair throughout the night and was afraid to fall asleep until Staff #2 (S2) found them the following morning. R1 stated they did not use their call button that night. R1 also reported that they enjoy living at the facility, that the Administrators address concerns promptly, and that staff generally treat them well. R1 denied experiencing disrespect or mocking from staff and expressed a preference for certain caregivers.

S1 reported that R1 typically returns from Dialysis between 6PM and 6:30PM, waits about an hour before requesting dinner due to post-treatment weakness, and then receives assistance with bedtime preparation around 8:30PM. On 01/21/2026, S1 stated that R1 refused assistance and requested a specific caregiver who was not scheduled. S1 reported offering assistance multiple times, but R1 allegedly became angry and yelled at S1 to leave. When S2 arrived for their shift, S1 informed them of R1’s refusals. S2 attempted to assist but was also unsuccessful. S2 reported checking on R1 every two (2) hours and leaving R1’s door slightly ajar to maintain visual monitoring due to R1’s agitation and yelling. S2 observed R1 to sleep and watch TV in their wheelchair throughout the night. S2 stated that R1 used their call button once and also called the facility phone between 4AM and 5AM requesting restroom assistance. Additional staff interviews indicated that R1 frequently refuses assistance and requests specific caregivers who may not be available, though staff attempt to accommodate these preferences. Staff denied witnessing or engaging in disrespectful behavior toward residents.

Report Continued on LIC 9099-C

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)

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Control Number 29-AS-20260127152355

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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A review of the facility’s internal incident reports revealed four (4) additional occurrences involving R1’s refusals and aggressive behavior toward staff. R1 had also made a secondary claim of not receiving assistance overnight; however, the facility’s investigation determined that staff had provided care. Facility service logs for 01/21/2026 to 01/22/2026 documented that R1 received “Aid Incidentals” at 6:41PM, Quality Check at 7:41PM, Meal Service at 7:45PM, Quality Check at 12:38AM, and Incontinent Care at 9:02AM. Staff reported they were unable to scan the QR code in R1’s room to confirm additional Quality Checks due to R1’s refusals. Although S2’s assistance between 4AM and 5AM was not logged, an Unusual Incident Report documented that R1 used their call button at 4:30AM requesting assistance.

R1’s Physician’s Report dated 02/20/2025 documented a diagnosis of end stage renal disease requiring Dialysis treatment. At that time, R1 was not noted to be disoriented, aggressive, or depressed and was able to follow instructions and communicate their needs. Individual Service Place (ISP) dated 08/01/2025 later documented R1 additional diagnoses of depression and an unspecified mental disorder. The ISP noted that R1 has difficulty remembering and using information, experiences some difficulty in new situations, and sometimes demonstrates impaired judgment. R1 also exhibited agitation, disruptive or aggressive behavior, and emotional states that created frequent difficulties with others. The ISP emphasized that maintaining open communication with R1 is essential to establishing trust, safety, comfort, and social engagement.

Based on interviews and record review, although the allegations may have happened or are valid, there is insufficient evidence to prove the alleged violations did or did not occur therefore the allegations are deemed UNSUBSTANTIATED at this time.

No deficiency cited. Exit interview conducted. A copy of the 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)

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