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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005936
Report Date: 11/14/2024
Date Signed: 11/14/2024 11:25:43 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/06/2024 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20241106151557
FACILITY NAME:ROYALIST HOME CAREFACILITY NUMBER:
306005936
ADMINISTRATOR:ASAWADILOKCHAI, YANINEEFACILITY TYPE:
740
ADDRESS:6001 ROYALIST DRIVETELEPHONE:
(714) 655-6454
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92647
CAPACITY:6CENSUS: 6DATE:
11/14/2024
UNANNOUNCEDTIME BEGAN:
08:26 AM
MET WITH:Taveewan Kaewma-CaregiverTIME COMPLETED:
11:40 AM
ALLEGATION(S):
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Facility did not obtain a fire clearance for bedridden resident
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Alvaro Ramirez, Jr. and Brandon Lopez conducted an unannounced visit to deliver findings on the above allegation received on November 06, 2024. LPAs were greeted and granted entry into the facility and met with Caregiver Taveewan Kaewma. LPAs explained the reason for the visit. Administrator (AD) Yaninee Asawadilokchai was notified by staff via telephone.

This agency has investigated the complaint alleging that facility did not obtain a fire clearance for bedridden resident . Resident 1 (R1) was admitted to the facility on August 22, 2024. Regarding the allegation, the following was revealed: During the course of the investigation LPAs reviewed documents including the Physician Report (LIC602) dated August 27, 2024 for R1. Per Physician Report R1 is non-ambulatory and has a diagnoses of Dementia. LPA reviewed the Apex Hospice Care, Inc. Plan of Care (POC) dated October 08, 2024 for R1. Per POC for R1 under intervention it states turn and reposition patient frequently to avoid any further skin integrity issues.
CONTINUED ON LIC9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
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 22-AS-20241106151557
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ROYALIST HOME CARE
FACILITY NUMBER: 306005936
VISIT DATE: 11/14/2024
NARRATIVE
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During the course of the interviews with staff, Staff 1 (S1) reported that R1 is not bedridden and stated that R1 has not had a change in condition since being admitted to the facility. During the course of the interviews with witnesses, Witness 1 (W1) reported that R1 assists to reposition themselves.

Based on the information gathered during the investigation and review of documents obtained, LPAs are unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed UNSUBSTANTIATED.

For today’s visit, there were no citations issued per Title 22, Division 6 of the California Code of Regulations.


LPA conducted an exit interview with facility representative, and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.
LICENSING EVALUATOR SIGNATURE:

DATE: 11/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2