197608244-11-4-2025-11-AS-EMAZ-DNMVX4-20251121154854

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608244
Report Date: 11/04/2025
Date Signed: 11/04/2025 04:50:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/28/2025 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20251028083739

FACILITY NAME:	ROYAL PALMS VILLA		FACILITY NUMBER:	197608244
ADMINISTRATOR:	MARIVI PITTS		FACILITY TYPE:	740
ADDRESS:	17419 ELGAR AVENUE		TELEPHONE:	(310) 817-4298
CITY:	TORRANCE	STATE: CA	ZIP CODE:	90504
CAPACITY:	6	CENSUS: 4	DATE:	11/04/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Bienvenido 'Bien' Cadungog		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not ensure the facility grounds are kept clean

INVESTIGATION FINDINGS:

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On 11/04/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Complaint Visit to the facility listed above. LPA met with Administrator Bienvenido 'Bien' Cadungog and Caregiver Ja Feliciano, and the purpose of today’s visit was explained. LPA was granted entry into the facility.

The investigation consisted of the following:

During today’s visit, LPA inspected the inside and outside the facility, interviewed Staff S1-S4, interviewed Residents R1-R4, and received and reviewed the Staff Roster, Resident Roster and guidelines and instructions for Large Item Pick Up.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025

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 11-AS-20251028083739

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: ROYAL PALMS VILLA	FACILITY NUMBER: 197608244
	VISIT DATE: 11/04/2025

NARRATIVE

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Allegation: Staff did not ensure the facility grounds are kept clean.
The allegation alleges that the facility dumps trash around the house, and they pile the garbage five feet over the trash can.

When LPA arrived at the facility, staff were observed cleaning the kitchen counters and mopping the floors. During the plant inspection, LPA observed the front yard was clean and maintained. LPA did not observe any unused appliances or furniture in the front. In the backyard, LPA observed the patio with a table and chairs, and all walkways were clean, clear, and free of obstructions, debris, and hazards. LPA observed behind the garage two (2) dressers, four (4) chairs, a washer, and refrigerator that are being stored there from a closed facility. During an interview with the Administrator (S1), stated they are moving the furniture and appliances out of the closed facility and plan on using them at the other facilities. The items stored behind the garage are not visible from the street and do not interfere with the residents’ accessibility to the backyard.

LPA received and reviewed Large Item Pick Up, for the city, Guidelines and Instructions that states items cannot be placed on private property, the items should be placed where the recycling is picked up, and items can be placed out 12 hours before pickup is scheduled.
During interviews with Staff S1-S4, were asked how often the outside is cleaned and picked up, four (4) out of four (4) stated a gardener comes every other week to cut the grass and staff pick up the yard if they see something while watering the plants. Additionally, Staff S1-S4 were asked if they had furniture or appliances in the front, four (4) out of four (4) stated they had a Large Item Pick Up a few weeks ago.
During interviews with Residents R1-R4, were asked if the staff keep the front and back yard clean, four (4) out of four (4) stated yes, it is kept clean.

During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

LPA did not observe or cite any deficiencies.
An exit interview was conducted with conducted with Caregiver, Ja Feliciano, and a copy of this report was provided.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2025

LIC9099 (FAS) - (06/04)

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