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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 361881297
Report Date: 10/23/2024
Date Signed: 10/23/2024 12:06:42 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2024 and conducted by Evaluator Javier Prieto
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20241015100221
FACILITY NAME:ROYAL PARADISE SENIOR LIVING LLC, THEFACILITY NUMBER:
361881297
ADMINISTRATOR:CUSTODIO, ERNESTO JRFACILITY TYPE:
740
ADDRESS:10132 DEVON STTELEPHONE:
(909) 919-6342
CITY:RANCHO CUCAMONGASTATE: CAZIP CODE:
91730
CAPACITY:6CENSUS: 5DATE:
10/23/2024
UNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Athena Custodio, LicenseeTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not providing adequate care to residents.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conduct a complaint investigation regarding the above allegation. LPA Prieto met with licensee Athena Custodio and explained the elements of the complaint.

Regarding allegation #1, LPA Prieto interviewed residents R1, R2, R3, R4 and R5. All residents interviewed state that the service is more than adequate and enough staff are around to meet their needs. LPA Prieto interviewed both staff at the facility, each stating the care for the clients are being met and there are sufficient staff to meet those needs. During this investigation, bathing aide arrived to meet R4 and conduct that service. LPA Prieto obtained facility daily routine schedule for staff and their responsibilities of the care provided to the residents in care.
Based on the information obtained there is not enough evidence that's staff are not providing adequate care to the resident. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. This report was signed by LPA Prieto and licensee Custodio and a copy of the report was left with the facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Javier Prieto
LICENSING EVALUATOR SIGNATURE:

DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024
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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