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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331881033
Report Date: 04/18/2026
Date Signed: 04/18/2026 01:26:03 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/24/2025 and conducted by Evaluator Paola Guerrero
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20250124141042
FACILITY NAME:ROYALTY SENIOR LIVINGFACILITY NUMBER:
331881033
ADMINISTRATOR:RILEY, TA'NEISHAFACILITY TYPE:
740
ADDRESS:10104 KINGS CTTELEPHONE:
(951) 416-1064
CITY:JURUPA VALLEYSTATE: CAZIP CODE:
92509
CAPACITY:6CENSUS: 2DATE:
04/18/2026
UNANNOUNCEDTIME BEGAN:
11:38 AM
MET WITH:Ta’Neisha RileyTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff is not allowing resident to return to facility for re-entry.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Paola Guerrero arrived at the facility to deliver investigative findings. LPA met with Facility Administrator Ta’Neisha Riley and explained the purpose of the visit regarding the allegations stated above.

First allegation: Staff is not allowing resident to return to facility for re-entry. Regarding the allegation stated above, LPA conducted an interview with Staff #1 regarding the alleged allegation Staff #1 informed LPA that on January 21,2025 Resident #1 was taken to the hospital due to a witness fall. Staff #1 further indicated that Resident #1 was later transported to the hospital via ambulance due to abnormal vitals. Staff #1 informed LPA that while Resident #1 was at hospital the hospital had discovered that Resident #1 was having an irregular heart rhythm which prompted the hospital to admit Resident #1. Staff #1 informed LPA that Resident #1 was admitted on January 22,2025 for further evaluation. Staff #1 informed LPA that while R#1 was at the hospital family informed Staff #1 that Resident #1 may longer be suitable to go back to the facility as Resident #1 needs to be placed at a facility with higher level of care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2026
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 2
Control Number 56-AS-20250124141042
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: ROYALTY SENIOR LIVING
FACILITY NUMBER: 331881033
VISIT DATE: 04/18/2026
NARRATIVE
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Staff #1 informed LPA that on January 22, 2025, at 9:31 am Staff #1 was informed by family that Resident#1 was assessed and will be placed to new facility (Southwoods Living) upon resident’s discharge. Staff #1 informed LPA that Resident #1 was discharged from Kaiser on January 28,2025 and was transported and admitted to their new facility Southwoods Living. Staff #1 denied the allegation of “not allowing resident to return back to the facility” and stated that Resident #1 family discharged the resident from the facility and placed Resident #1 at Southwoods living facility to be closer to family. Based on corroborating evidence LPA has determined that the above allegation is Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report (LIC 9099) was discussed, and a copy was provided to Facility Administrator Ta’Neisha Riley.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Paola Guerrero
LICENSING EVALUATOR SIGNATURE:

DATE: 04/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2