Montclair Royale Senior Living

Type of visit: Required - 1 Year

On 9/17/2026 at 12:35PM, Licensing Program Analysts (LPAs) Eldin Serrano and Sarina Ramirez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPAs met with Care Coordinator Araceli Soto and was granted entry to the facility. Staff called Administrator Anna Marie Santos who later arrived. At the time of the visit there were twenty seventeen (17) staffs present. The facility is a eighty four (84) bedrooms, eighty four (84) bathroom facility with a kitchen/dining area, living room/activity room, TV room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of eighty six (86) ambulatory, one hundred fifty (150) non ambulatory, fifteen (15) hospice care and 15 maybe bedridden resident and the current census is one hundred twenty one (121) residents. LPAs were accompanied by care coordinator to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 78 degrees fahrenheit. LPAs inspected resident bedrooms; they are equipped with the required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPAs observed sufficient furniture and lighting throughout the facility. LPAs measured and observed the water temperatures in the bathroom for room #126 to be at 113.3 degrees Fahrenheit, Room# 201 to be at 118 degrees Fahrenheit, Room #335 to be at 114 degrees Fahrenheit . The facility is equipped with operating smoke detectors and carbon monoxide detectors. ***Continuation in LIC809C *** Fire extinguishers were observed on every floor at the facility. Posters such as personal rights, the CCLD complaint poster, ombudsman poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine Room with the resident’s medications locked. LPAs observed complete first aid kit and first aid book at the facility. Food Service: Seven (7) days’ supply of Non-perishable foods and two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The Administrator was present in the facility at the time of the visit with enough hours to appropriately manage the facility. Record Review: LPAs reviewed six (6) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. No issues observed. LPAs reviewed six (6) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) Test result. LPAs observed that staff #1 (S1) does not have an updated health screening report. Technical Violation issued. LPAs observed that one kitchen staff does not have an updated food handler certificate. Technical Violation issued Medications/Medication Administration Record (MAR) were audited for 6 residents. No issues observed. Based on the observations made during today’s visit, No deficiency was issued per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C, and LIC9102 forms were discussed and provided to Administrator Anna Marie Santos.the state’s words, verbatim · CDSS document, Sep 17, 2026

The state marks this report as 5 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Staff did not prevent residents from engaging in inapprorpiate behaviors Staff did not prevent residents from hitting resident resulting in injuries Staff did not safeguard residents personal belongings

On 8/10/2026 at 12:40 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to investigate and deliver the findings of the above allegations. LPA Serrano met with administrator Anna Marie Santos to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation. Allegation 1: Staff did not prevent residents from engaging in inappropriate behaviors - Based on interviews conducted with relevant parties, all individuals stated that staff intervene and redirect residents if any inappropriate behavior occurs. No witnesses or evidence substantiated the claim that staff failed to take action. Therefore, LPA was unable to corroborate this allegation. Allegation 2: Staff did not prevent residents from hitting another resident, resulting in injuries - All interviewed parties reported that they had not observed or witnessed any incidents of residents hitting other residents. They also stated that staff would intervene immediately if such an event occurred. No evidence was found to support the allegation. Therefore, LPA was unable to corroborate this allegation. *****continue on LIC9099C****** Unsubstantiated Allegation 3: Staff did not safeguard residents’ personal belongings - Interviews with relevant parties indicated that no personal property had been reported stolen. Some residents occasionally misplace items but later locate them. Record reviews showed that Resident 1 (R1) did not list any personal property or valuables on the inventory form signed upon admission. Due to a lack of evidence to support the claim, this allegation is determined to be unsubstantiated. Information received during investigation LPA did not find evidence to corroborate the allegations. Based on the file review and interviews, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to administrator Anna Marie Santos.the state’s words, verbatim · CDSS document, Aug 10, 2026 · control 56-AS-20260622160625

Allegation investigated: Staff do not maintain the facility in sanitary condition Staff are not addressing pests at the facility Staff do not provide residents with adequate laundry service

On July 16, 2026, at 12:20 PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to commence the complaint investigation and deliver findings for the above allegations. LPA explained the purpose of the visit to Care Coordinator Araceli Soto. The investigation consisted of a records review, interviews with staff and a resident, as well as observations throughout the facility. The allegations indicate the following: 1. Staff do not maintain the facility in sanitary condition Based on observation and records review, LPA observed staff actively cleaning resident rooms and maintaining overall cleanliness and sanitation throughout the facility. The facility also provided a housekeeping schedule indicating regular cleaning practices. LPA was unable to corroborate this allegation. 2. Staff are not addressing pests at the facility Based on records review, the facility has an active service agreement with a pest control company responsible for monitoring and controlling pests on an ongoing basis. LPA was unable to corroborate this allegation. *** Continuation in LIC9099C *** Unsubstantiated 3. Staff do not provide residents with adequate laundry service Based on observation and records review, the facility has a contract with Ecolab for the supply of laundry soap, chemical supplies, and laundry equipment used throughout the facility. The facility also provided a staff laundry schedule. LPA was unable to corroborate this allegation. Based on the evidence obtained, including observations and records review, the allegations listed above are UNSUBSTANTIATED. A finding that a complaint is UNSUBSTANTIATED means that although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur; therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, during which this report LIC 9099 and LIC 9099C were discussed and provided to Care Coordinator Araceli Soto.the state’s words, verbatim · CDSS document, Jul 16, 2026 · control 56-AS-20260713084005

From the deficiency page — Deficiency type: Type A · Section cited: CCR 80088(a) · Plan of correction due date: Jul 17, 2026

Title 22, Division 6 Chapter 1 80088 (a) Furniture, Fixtures, Equipment, and Supplies (a) A comfortable temperature for clients shall be maintained at all areas. This requirement is not met as evidence by: Based on observation, the licensee did not comply with the section cited above by not ensuring that a comfortable temperature is maintained throughout the facility for the residents in care specially in hot weather season which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 16, 2026

Plan of correction: Licensee/Administrator shall submit a work order/invoice from a licensed heating/ventilation air-conditioning company (HVAC) that showed that the HVAC will fix the issue of facility uncomfortable temperature by plan of correction (POC) due date

Allegation investigated: Staff do not ensure a clean and sanitary environment Staff do not ensure facility is in good repair

Licensing Program Analyst (LPA) Javier Prieto arrived to the facility to conclude a complaint investigation regarding the above allegation. LPA Prieto met with Administrator Santos and explained the elements of the complaint. Allegation #1 - LPA toured the Assisted Living area, dinning room, library and other common areas. LPA toured resident's rooms and found carpets are clean and sanitary. Facility has staff that cleans carpets on a daily basis and upon resident request. LPA did not observe any unsafe environmental conditions that may pose a risk to resident's safety. Allegation #2 - LPA toured the Assisted Living area, dinning room, library and other common areas. LPA also toured the facility Memory Care Unit ward and found all to be clean, sanitary and in good repair. LPA found the facility halls and corridors were observed to be free from obstruction. LPA did not observe any unsafe environmental conditions that may pose a risk to resident's safety. Unsubstantiated Based on the information obtained there is not enough evidence that staff do not ensure facility is in good repair and staff do not ensure a clean and sanitary environment. Therefore, the allegation is deemed UNSUBSTANTIATED at this time. This report signed by LPA Prieto and Administrator Santos and a copy was left with the facility.the state’s words, verbatim · CDSS document, May 5, 2026 · control 56-AS-20260416144904

Allegation investigated: Staff inappropriately changed resident's rent without notice

On 3/11/2026 at 8:55 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to investigate and deliver the findings of the above allegation. LPA Serrano met with Care Coordinator Araceli Soto to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation. Allegation: Staff inappropriately changed resident's rent without notice – Based on record reviews and interviews with relevant parties, the facility does not change residents’ rent without prior notice. Four out of five residents reported that rent is adjusted annually based on their benefits and that they are informed in advance of any changes. The allegation cannot be substantiated. Information received during investigation LPA did not find evidence to corroborate the allegation. *** Continuation in LIC9099C *** Unsubstantiated Based on the evidence, the allegation mentioned above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Care Coordinator Araceli Soto.the state’s words, verbatim · CDSS document, Mar 11, 2026 · control 56-AS-20260305141429

Type of visit: Case Management - Incident

On March 2, 2026, at 12:15 PM, Licensing Program Analyst (LPA) Eldin Serrano arrived unannounced at the facility to conduct a Case Management Visit in response to a self-reported incident received by the Community Care Licensing Office on February 26, 2026. LPA was greeted by Administrator Anna Marie Santos, introduced himself, and stated the purpose of the visit. During the visit, LPA interviewed residents regarding the allegation that a staff member borrowed money from a resident. As the staff member is no longer employed at the facility, the allegation cannot be verified. LPA also investigated a report that a resident sold narcotics to another resident; interviews with relevant parties revealed no witnesses, and this allegation could not be substantiated. A third allegation, involving staff disclosing personal information about other residents, could not be verified due to the unavailability of individuals involved. No deficiencies were observed during this visit. An exit interview was conducted during which the report was reviewed, discussed, and provided to Administrator Anna Marie Santos.the state’s words, verbatim · CDSS document, Mar 2, 2026

Allegation investigated: Staff are mismanaging residents' medications. Staff are not ensuring residents' needs are being met due to inadequate staffing. Staff are engaging in inappropriate behavior in the presence of residents

On 2/09/2026 at 10:40 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to investigate and deliver the findings of the above allegations. LPA Serrano met with care coordinator Araceli Soto to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation. Allegation #1: Staff are mismanaging residents' medications. – Interviews with staff and residents confirmed that medications are administered as prescribed. The facility will implement a new system to discontinue the use of serving cups and has contracted with a pharmacy to provide multi-pack medications that are clearly labeled with dates, names, and times to improve efficiency and reduce errors. The LPA observed the medication cart to be securely locked. LPA was unable to corroborate the allegation. *** Continuation in LIC9099C *** Unsubstantiated Allegation #2: Staff are not ensuring residents' needs are being met due to inadequate staffing. – Interviews with staff and residents confirmed that staff provide regular diaper changes and scheduled showers. It was confirmed that when the residents pressed their call light button, the staff promptly answered and responded to their needs. No evidence of staffing shortages was observed; therefore, the allegation could not be substantiated. Allegation #3: Staff are engaging in inappropriate behavior in the presence of residents. – Interviews with staff and residents confirmed that no staff member was observed or witnessed engaging in inappropriate behavior or romantic relationship toward another staff member in the presence of residents. LPA was unable to corroborate the allegation. Information received during investigation LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Care Coordinator Araceli Soto.the state’s words, verbatim · CDSS document, Feb 9, 2026 · control 56-AS-20260130111357

Allegation investigated: Staff do not ensure that rooms occupied by the residents are heated to a minimum of 68 degrees

On 2/09/2026 at 10:00 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to investigate and deliver the findings of the above allegations. LPA Serrano met with care coordinator Araceli Soto to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation. Allegation: Staff do not ensure that rooms occupied by the residents are heated to a minimum of 68 degrees - Interviews with staff and residents indicated that maintenance adjusts the dining hall temperature when residents feel cold. The head of maintenance reported a low thermostat battery caused a temporary malfunction, which was promptly fixed. According to maintenance the incident occurred only once. It was revealed that some residents tampered with the thermostat, and was the reason why the temperature always changed, so staff installed a locked cover to prevent changes. LPA could not substantiate the allegation. *****continuation on LIC9099C****** Unsubstantiated Information received during investigation LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Care Coordinator Araceli Soto.the state’s words, verbatim · CDSS document, Feb 9, 2026 · control 56-AS-20260115131906

Allegation investigated: Staff do not distribute residents' medications as prescribed Staff confine resident to wheelchair Staff do not maintain facility in good repair Staff do not follow proper medication management protocol

On 2/09/2026 at 8:55 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to investigate and deliver the findings of the above allegations. LPA Serrano met with care coordinator Araceli Soto to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation. Allegation #1: Staff do not distribute residents' medications as prescribed – Interviews with staff and residents confirmed that medications are administered according to prescription. Staff place medications in a serving cup, provide them to the residents, and observe the resident taking them with water. There was no evidence that staff used a deceased resident’s medication for another resident, even when prescriptions were identical. LPA was unable to substantiate the allegation. ******continuation on LIC9099C***** Unsubstantiated Allegation #2: Staff confine resident to wheelchair – Based on LPA’s observation, resident #1 (R1) was not restrained and did not have a gait belt that could confine R1 to the wheelchair. Interviews with residents and staff confirmed that no residents were confined to wheelchairs by staff. Therefore, the allegation could not be substantiated. Allegation #3: Staff do not maintain facility in good repair – Based on LPA observation, it was confirmed that the exit door near room 309 is in good repair. There was no indication that the exit door was ever broken or replaced. LPA was unable to corroborate the allegation. Allegation #4: Staff do not follow proper medication management protocol – Staff interviews confirmed that only the administrator or care/nurse coordinator are authorized to destroy narcotics. MedTech staff prepare the required documentation and transfer the medication to the administrator or care coordinator for disposal. For non-narcotic medications, two MedTech staff must jointly dispose of them in a designated container, which the pharmacy collects when full. LPA observed that the medication carts are always locked and need a key to access them. The LPA was unable to substantiate the allegation. Information received during investigation LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Care Coordinator Araceli Soto.the state’s words, verbatim · CDSS document, Feb 9, 2026 · control 56-AS-20260113154442

Allegation investigated: Staff does not seek medical attention to resident in care. Staff does not prevent the spread of bodily fluids of resident.

Licensing Program Analyst (LPA) Raquel Hernandez conducted an unannounced visit to deliver findings on the allegations listed above. LPA met with Administrator Annamarie Santos and explained the purpose of the visit. The investigation consisted of resident and staff interviews. For the allegation, Staff did not seek medical attention to resident in care. LPA reviewed Resident #1 (R1) file review which indicated medical attention was given to R1 while residing at the facility. LPA conducted (3) staff interviews. Staff interviews revealed medical attention was given to R1. For the allegation, Staff does not prevent the spread of bodily fluids of resident. LPA reviewed R1’s care notes which indicated R1 declined emergency services and medical help for wound on foot. LPA conducted (3) staff interviews that revealed R1 did have a wound on foot but facility staff do not recall witnessing issues with bodily fluids or open wounds. Unsubstantiated Based on the evidence gathered during today’s investigation, the allegations listed above are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and this report (LIC9099) along with other reports were discussed and provided to Administrator Annamarie Santos.the state’s words, verbatim · CDSS document, Dec 18, 2025 · control 56-AS-20230412140600

Allegation investigated: Staff do not properly maintain the facility Staff do not keep the facility free from scabies Staff do not prevent the residents from being exposed to a prohibited health condition

On 12/17/2025 at 12:55PM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to investigate and deliver the findings of the above allegations. LPA Serrano met with care coordinator Araceli Soto to explain the purpose of the visit. The investigation consisted of file review, interviews with facility staff and residents as well as facility observation. Allegation #1: Staff do not properly maintain the facility – Based on information received during staff and resident’s interviews, all of them stated that the staff and housekeeping clean their room every day. LPA observed staff vacuuming, shampooing and cleaning the carpet in resident rooms and in hallways. Facility also provided the housekeeping schedule. LPA was unable to corroborate the allegation. Allegation #2: Staff do not keep the facility free from scabies - Based on interviews with residents and staff, all of them stated that they have not had any scabies cases for a while and no scabies cases lately. LPA was unable to corroborate the allegation *** Continuation in LIC9099C *** Unsubstantiated Allegation #3: Staff do not prevent the residents from being exposed to a prohibited health condition - Based on interviews and information received during the investigation 6 out of 6 staff and 8 out 8 residents stated that the facility staff take preventive measures to make sure the residents are not exposed to any prohibited health conditions. Staff stated that they used personal protective equipment (PPE) every time they attend to any sick resident to prevent spreading the disease. The facility also quarantined the resident that was sick. LPA is unable to corroborate the allegation. Information received during investigation LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 was discussed and provided to Care Coordinator Araceli Soto.the state’s words, verbatim · CDSS document, Dec 17, 2025 · control 56-AS-20251211104112

Allegation investigated: Staff did not properly intervene when another resident verbally/physically attacked another resident

On 12/17/2025 at 02:00PM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegation. LPA discussed the purpose of the visit with Care Coordinator, Araceli Soto. The investigation consisted of interviews and record review. In regards to the allegation of staff did not properly intervene when another resident verbally/physically attacked another resident : LPA interviewed three (3) staff , (8) residents and the relative of Resident 1 (R1). Staff stated that Resident 2 (R2) was relocated to another room and was discharged from the facility on 10/13/2025. Staff stated that they redirect and offered R1 and R2 assistance. The relative of R1 stated that staff kept R1 safe. Residents stated that staff assist when residents have concerns. Based on interviews and record review, this allegation is UNSUBSTANTIATED. Unsubstantiated UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted where this report LIC9099 and LIC9099C was discussed and copies were provided to Care Coordinator, Araceli Soto.the state’s words, verbatim · CDSS document, Dec 17, 2025 · control 56-AS-20250812113518

Allegation investigated: Staff does not ensure facility carpet is in good repair Staff does not ensure outside premises is in good repair Staff does not ensure outside patio is clean

On 12/16/2025 at 10:00AM Licensing Program Analyst (LPA) Renese Howell-Small conducted an unannounced visit to the facility in order to deliver findings for the above allegations. LPA discussed the purpose of the visit with Administrator, AnnaMarie Santos. The investigation consisted of interviews, observation and record review. LPA completed a tour of the facility with Care Coordinator, Ariceli Soto. In regards to the allegation of staff does not ensure facility carpet is in good repair: LPA interviewed staff and residents. LPA observed staff vacuuming, shampooing and cleaning the carpet in resident rooms and in hallways. Residents stated that staff take care of the carpet. Staff stated that the facility is in the process of replacing carpet in certain areas of the facility. Based on interviews and observation, this allegation is UNSUBSTANTIATED. Unsubstantiated In regards to the allegation of staff does not ensure outside premises is in good repair: LPA observed that there were no obstructions to outdoor passageways. The walkway was level, stable and easy to navigate. LPA observed several residents using wheeled devices navigate the area with ease. Based upon interview and observation, this allegation is UNSUBSTANTIATED. In regards to the allegation of staff does not ensure outside patio is clean: LPA observed the outdoor patio area to be clean, well maintained and the furniture and cushions were in good condition. Staff stated that the gardeners come every two weeks and maintenance cleans the area daily. Based upon observation and interview, this allegation is UNSUBSTANTIATED. UNSUBSTANTIATED is defined as the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted where this report LIC9099 and LIC9099C was discussed and a copy was provided to Care Coordinator, Ariceli Soto.the state’s words, verbatim · CDSS document, Dec 16, 2025 · control 56-AS-20250819160849

Type of visit: Required - 1 Year

On 12/82025 at 09:30AM, Licensing Program Analysts (LPAs) Eldin Serrano, Sarina Ramirez and Andrew Martinez made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPAs met with Care Coordinator Araceli Soto and was granted entry to the facility. At the time of the visit there were twenty five (25) staffs present, and one hundred thirty three (119) residents present. The facility is a eighty four (84) bedrooms, eighty four (84) bathroom facility with a kitchen/dining area, living room/activity room, TV room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of eighty six (86) ambulatory, one hundred fifty (150) non ambulatory, fifteen (15) hospice care and 15 maybe bedridden resident and the current census is one hundred nineteen (119) residents. LPAs were accompanied by care coordinator to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees Fahrenheit. LPAs inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPAs observed sufficient furniture and lighting throughout the facility. LPAs measured and observed the water temperatures in the bathroom for room #107 to be at 107.4 degrees Fahrenheit, Room# 223 to be at 110.1 degrees Fahrenheit, Room #303 to be at 117.5 degrees Fahrenheit . The facility is equipped with operating smoke detectors and carbon monoxide detectors. ***Continuation in LIC809C *** Fire extinguishers were observed on every floor at the facility. Posters such as personal rights, the CCLD complaint poster, ombudsman poster, labor laws, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine Room with the resident’s medications locked. LPAs observed complete first aid kit and first aid book at the facility. Food Service: Seven (7) days’ supply of Non-perishable foods and two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The Administrator was not present in the facility at the time of the visit but observed the schedule with enough hours to appropriately manage the facility. Record Review: LPAs reviewed five (5) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans.LPAs reviewed six (6) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) Test result. LPAs observed staff #3 (S3) do not have the required tuberculosis (TB) test and TB test result. Technical violation issued. Medications/Medication Administration Record (MAR) were audited for 5 residents. LPA observed that resident #1,#2 (R1, R2) has their medication still in the bubble pack and not dispensed. Deficiency issued. Based on the observations made during today’s visit, one (1) deficiency and one (1) technical violation were issued per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report LIC809, LIC809C, LIC809D and LIC9102 forms, and Appeal Rights were discussed and provided to Care Coordinator Araceli Soto.the state’s words, verbatim · CDSS document, Dec 8, 2025

The state marks this report as 5 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff did not meet resident's toileting needs Staff did not meet resident's grooming needs Staff are limiting resident's water intake

On 10/21/2025 at 12:08 PM, Licensing Program Analyst (LPA) LaVette Farlow made an unannounced visit to the facility to deliver the findings of the above allegations. LPA Farlow explained the purpose of the visit to the Assistant Administrator/Care Coordinator Araceli Soto. The investigation consisted of interviews with staff and residents as well as a tour of the facility. The investigation was conducted by LPA Farlow and LPA Howell-Small. The investigation consisted of interviews with relevant parties. 1 allegation : Staff did not meet resident's toileting needs. Based on residents and staff interviews, 7 out of 7 residents and 8 out of 8 staff stated that they did not hear of or observed staff not assisting residents with toileting needs. The residents stated that staff are friendly and assist them with their needs. *** Continuation in LIC9099C *** Unsubstantiated R5 and R6 stated that the staff are always nice and treat them well. Based on the information and interviews the allegation is UNSUBSTANTIATED. 2 allegation : Staff did not meet resident's grooming needs. Based on residents and staff interviews, 7 out of 7 residents and 8 out of 8 staff stated that they are not aware of any problems or observed staff not willing to assist residents with grooming needs. 7 out of 7 residents stated staff assist as needed, with showers, and grooming. 8 out of 8 staff reporting assisting with showers, changing of depends and assisting residents with combing of their hair. Based on the information and interviews the allegation is UNSUBSTANTIATED. 3 allegation : Staff are limiting resident's water intake. LPA conducted interviews with staff and residents. Based on residents and staff interviews it was report that the facility provide 3 meals and 3 snacks a day with a variety of drink options. The residents have an options to have water, juice, coffee, tea, and soda. S1 and S2 stated we ensure that residents are provided 3 meals a day and 3 snacks in between meals. During this time we ensure residents are hydrated. We off the residents a variety of fluids to maintain hydration. LPA's interview with residents revealed that staff provide plenty of liquid for residents in care. Based on the information and interviews the allegation is UNSUBSTANTIATED. During the investigation, LPA did not find evidence to corroborate the allegations. Based on the evidence, the allegations mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Receptionist Grace Rodriguez.the state’s words, verbatim · CDSS document, Oct 21, 2025 · control 56-AS-20250730212708

Allegation investigated: Uncleared staff providing care to residents

Licensing Program Analyst (LPA) Becky Mann conducted an unannounced visit to the facility to initiate a complaint investigation. LPA met with Araceli Soto, Care Director and explained the purpose of the visit. The investigation consisted of LPA pertinent record reviews, observations and interviews with staff and residents. LPA interviewed three (3) staff and three (3) residents. Based on the interviews, Staff #1 (S1) does currently work at the facility. Based on LPA observations and record reviews, S1 does not have a criminal record clearance to work at the facility. Therefore, the facility is being cited for failure to have S1 fingerprint cleared before working at the facility. This citation requires a civil penalty of $100 per day per individual for the maximum of 5 days. Total civil penalties $500. A Plan of Correction (POC) was created with the Care Director Soto. Substantiated Based on LPA observations, interviews and records review, the above allegation is Substantiated. A determination that the complaint is substantiated means that the allegation is/are valid because the preponderance of the evidence standard has been met. An exit interview was conducted where this report, along with LIC421BG, appeal rights and LIC9099D page was reviewed and provided to Araceli Soto, Care Director.the state’s words, verbatim · CDSS document, Jun 26, 2025 · control 56-AS-20250623090801

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87355(b)(2) · Plan of correction due date: Jul 3, 2025

87355 Criminal Record Clearance (a) The Dept shall conduct a criminal record review of all individuals specified in Health and Safety Code section 1569.17 (b)Prior... residing in the facility shall have a criminal record clearance or exemption. This requirement was not met as evidenced by: Based on LPA observations, record reviews and interviews, Staff #1 (S1) did not have a criminal record clearance prior to working at the facility. This poses an immediate health, safety or personal rights risk to residents in carethe state’s words, verbatim · CDSS document, Jun 26, 2025

Plan of correction: Care Director agreed to send the LPA a written statement on how they plan on ensuring all staff are cleared going forward. This is due by the Plan of Correction (POC) due date.

Allegation investigated: Staff yells at resident.

On 4/2/2025 at 10 AM, Licensing Program Analyst (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegation. LPA Serrano explained the purpose of the visit to the Administrator Annamarie Santos-Tabila. The investigation consisted of interviews with staffs and residents as well as observation. The investigation was conducted by LPA Serrano. The investigation consisted of interviews with relevant parties. The allegation - Staff yells at resident. – Based on residents and staff interview,11 out of 12 residents and 8 out of 8 staff stated that they did not witness/observed or heard of any staff yelled at a resident. The residents stated that the staff are friendly and attend to their needs. One resident stated that the facility is like a family. The residents stated that the facility treated them very well. During the investigation, LPA did not find evidence to corroborate the allegations. *** Continuation in LIC9099C *** Unsubstantiated Based on the evidence, the allegation mentioned above are UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 and LIC9099C were discussed and provided to Administrator Annamarie Santos-Tabila.the state’s words, verbatim · CDSS document, Apr 2, 2025 · control 56-AS-20250325105649

Allegation investigated: Facility staff do not keep medications safe and locked

On 10/25/2024 at 9:30 AM, Licensing Program Analysts (LPA) Eldin Serrano made an unannounced visit to the facility to deliver the findings of the above allegation. LPA Serrano explained the purpose of the visit to the Resident Care Coordinator Araceli Soto. The investigation was conducted by LPA Serrano. The investigation consisted of records review, observation and interviews with relevant parties. The allegation indicates facility staff do not keep medications safe and locked. During the investigation, LPA did not find evidence to corroborate the allegation. Interviews with the Medtech Supervisor Juana Macias stated that all medication carts are locked all the time before the medtech staff go out of the medtech room to pass out medication to residents. The opened cart in particular with this allegation is just a supply cart for residents that do self administered insulin medication. *** Continuation in LIC9099C *** Unsubstantiated No medication is in that cart that was found open and not locked. Based on observation the Medtech room and medtech carts are always locked. If the residents need the insulin the medtech will hand them over the insulin from the refrigerator from the medtech room for them to administer themselves. Interviews with residents also indicated that the supply drawer is only for insulin residents and no actual medication is in that drawer/cart. Based on the evidence, the allegation that Facility staff do not keep medications safe and locked is UNSUBSTANTIATED. A finding that the complaint is UNSUBSTANTIATED means 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, therefore the allegation is unsubstantiated at this time. An exit interview was conducted where this report, LIC9099 was discussed and provided to Resident Care Director Araceli Soto.the state’s words, verbatim · CDSS document, Oct 25, 2024 · control 56-AS-20241018154624

Type of visit: Required - 1 Year

On 10/14/2024 at 09:15 AM, Licensing Program Analysts (LPA) Melody Brown and Eldin Serrano made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPAs Brown and Serrano met with Assitant Resident Care Coordinator Gwendolyne Galvan and was granted entry to the facility. At the time of the visit there were twenty seven (27) staffs present, and one hundred thirty three (133) residents present. The facility is a eighty four (84) bedrooms, eighty four (84) bathroom facility with a kitchen/dining area, living room/activity room, TV room. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of eighty six (86) ambulatory, one hundred fifty (150) non ambulatory, fifteen (15) hospice care and 15 maybe bedridden resident and the current census is one hundred thirty three (133) residents. LPAs Brown and Serrano was accompanied by ARCC to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing Division (CCLD). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 74 degrees Fahrenheit. LPAs inspected resident bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPAs observed sufficient furniture and lighting throughout the facility. LPAs measured and observed the water temperatures in the bathroom for room #104 to be at 114.4 degrees Fahrenheit, Room# 246 to be at 115.8 degrees Fahrenheit, Room #311 to be at 115.1 degrees Fahrenheit . The facility is equipped with operating smoke detectors and did not observe carbon monoxide alarms. LPAs observed that the facilty do not have the required carbon monoxide detector installed on each floor of the facility. Deficiency will be issued. ***Continuation in LIC809C *** ***Continuation in LIC809C *** Fire extinguishers were observed on every floor at the facility. Posters such as personal rights, the CCLD complaint poster, ombudsman poster, labor laws, and the disaster plan were posted in a common area. LPAs obeserved resident #1 (R1) and resident #2 (R2) with half bedrail but per interview and documents review there is no written order from their physician indicating the need for half bed rail for mobility, Defiiciency will be issued. LPAs observed floor surface in resident bathroom and the floor bathroom for residents and staff were not clean. Deficiency will be issued. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. There is a Medicine Room with the resident’s medications locked. LPAs observed complete first aid kit and first aid book at the facility. Food Service: More than seven (7) days’ supply of Non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care. Care & Supervision: The facility has no Administrator present in the facility with appropriate and enough hours to appropriately manage the facility. Based on interview and LPAs observation facility administrator was not present at the facility for three (3) consecutive weeks and not at the facility during working hours. Deficiency will be issued. Record Review: LPAs reviewed five (5) resident files for admission agreements, updated physician reports, pre-placement appraisals and needs and services plans. LPAS observed resident #2 (R2) does not have the required pre-placement appraisal. Deficiency will be issued. LPAs observed Resident #2 (R2) #3 (R3) and #4 (R4), does not have the signed and dated admission agreement. Deficiency will be issued. LPAS observed no completed needs and services for resident #5 (R5) and facility representative did not sign the completed needs and services plan for resident #2 (R2) and resident #4 (R4). deficiency will be issued. LPAs reviewed five (5) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) Test result. LPAs observed staff #4 (S4) does not have the required tuberculosis (TB) test and TB test result. Deficiency will be issued. LPAs observed staff #3 (S3) does not have the required updated ServSafe certification and staff #4 (S4) does not have the required update food handlers card. Deficiency will be issued. Medications/Medication Administration Record (MAR) were audited for 5 residents and no issues observed. However, LPAs observed resident #3 (R3) does not have the required annual medical assessment as required for resident with dementia as R3s medical assessment date is 08/12/2022. Deficiency will be issued. Also, LPAs observed that resident #2 (R2) is in memory care and per documents review R2 does not have a diagnosis of dementia but with a primary diagnosis of a mental disorder unrelated to dementia. Deficiency will be issued. Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809), LIC809D forms, and Appeal Rights were discussed and provided to Assistant Resident Care Coordinator Gwendolyne Galvan.the state’s words, verbatim · CDSS document, Oct 14, 2024

The state marks this report as 10 pages; the online copy we transcribed has 9. You can request the full file from the county licensing office.

Allegation investigated: Staff poses a risk to residents in care. Staff are not providing a safe environment to residents in care. Illegal Eviction

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Montclair Royale Senior Living facility to deliver findings of the complaint investigation into the allegations listed above. LPA met with Care Coordinator, Araceli Soto. During the investigation, LPA met with staff and residents for interviews and collected pertinent documents for record reviews. It is alleged that staff poses a risk to residents in care. During staff interviews it was revealed that R1 would not allow staff to provide him with services. R1 would not allow staff inside his room to provide assistance. LPA made observations of R1's room door - posted to the room door were hand written signs advising staff not to enter the room. Additionally, LPA observed staff's attempts to deliver and provide meals to R1. Meals delivered to R1's room sat on a bench untouched. According to recent Special Incident Reports, (SIR) R1 physically prevented staff from entering the room. Even when only checking in for safety. LPA made attempts to reach R1 for an interview with no success. Witness interviews are consistent with staff interviews, R1 is reported to be confrontational and not allow anyone entry to the room. Unsubstantiated It is alleged that, staff are not providing a safe environment to residents in care. LPA completed a walk through of the facility and made no observations of imminent dangers or health risks to the residents in care. R1's file contained all current and updated documentation per regulation. LPA was not able to meet with R1 to ask about the concerns R1 had for his safety at the facility. Staff interviews indicated R1 would not allow staff to enter R1's room; even for purposes of ensuring safety. When Staff attempted to enter the room or have any interaction with R1, staff was met with verbal and physical confrontation. A review of the SIR's supported this information. It is alleged that R1 is being illegally evicted from the facility. LPA reviewed the issued eviction documentation provided to R1, Special Incident Reports and Warnings provided to R1 before the eviction was officially issued. All documentation reviewed was correctly completed per regulation for evictions. R1 was being evicted for non-compliance of facility house rules. According to Administrator, AnnaMarie Santos-Tabila, at this time, R1 is illegally detaining the room. The set eviction date has come and gone. R1 and Facility management are working to settle the matter in court. LPA was unable to reach R1 for interview, evidence, statements or documentation that would support the facility was attempting to commit an illegal eviction. Based on interviews, record reviews and observations, these allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means 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. This report was reviewed, discussed, then provided to the facility representative.the state’s words, verbatim · CDSS document, Feb 23, 2024 · control 56-AS-20231208164611

Allegation investigated: Facility staff hit resident.

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Montclair Royale Senior Living Facility to deliver findings of the complaint investigation. LPA introduced self and stated purpose of the visit. During the complaint investigation, LPA completed a walk through of resident rooms, interviewed staff and witnesses and collected documentation. It is alleged that staff hit the resident. Staff interviews, revealed that during the week of November 12th – 18th, 2023 R1 suffered a total of three falls. R1 had a history of falls, declining assistance when offered and refusing medical treatment. According to witnesses, when staff did provide services R1 was resistant and combative with staff. All staff interviewed, denied hitting R1 or participating in any physical altercations. Record Reviews revealed that R1 needed assistance of staff with a number of Activities of Daily Living. The facility provides services to individuals who need assistance with activities of daily living; as well as those who suffer memory impairment. LPA unable to interview R1 as they are no longer residing at the facility. Unsubstantiated Based on information above, the allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means 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 with Facility Representative. This report was reviewed, discussed, then provided.the state’s words, verbatim · CDSS document, Jan 30, 2024 · control 56-AS-20231120100044

Allegation investigated: Illegal Eviction

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Montclair Royale Senior Living, Residential Care Facility for the Elderly unannounced to deliver the findings of the complaint investigation into the allegation listed above. It is alleged that the facility illegally evicted a resident from the facility. During staff interviews, LPA discovered that R1 was taken to the hospital, as the hospital was attempting to discharge the resident the facility was contacted. Staff reported to the hospital that the resident could not return based on the level of care she would require. A reappraisal was not completed before making arrangements to relocate the resident. Without the reappraisal, staff did not have an opportunity to assess the resident to determine what services the facility could or could not provide. Staff denied offering to accept the resident back into care for an additional fee of $1000. Interviews with the witness revealed that the resident went to the hospital and was subsequently relocated to another facility. Which did not give the resident and family the required 30 day notice to make such relocation efforts. Substantiated Based on record reviews and conflicting statements, the allegation is UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means 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 was reviewed, discussed and then provided to the facility representative. Based on record reviews and interviews, we have substantiated the complaint allegation(s) as valid and that a violation has occurred based on the preponderance of available evidence. A copy of this report along with appeal rights are being reviewed with, and furnished to the facility representative. Please see LIC 9099D. A copy of this report along with appeal rights are being reviewed with and furnished to the facility representative. ** A Civil Penalty assessment accompanies the deficiency. **the state’s words, verbatim · CDSS document, Dec 14, 2023 · control 56-AS-20231120222148

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(a) · Plan of correction due date: Dec 15, 2023

87224. Eviction Procedures (a)The licensee may evict a resident for one or more of the reasons...Thirty (30) days written notice to the resident is required... This requirement was not met as evidenced by: Based on record reviews and interviews the Administrator did not comply with the regulation listed above when the resident was relocated without a proper 30 day eviction notice. This posed an immediate Health, Safety and Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Dec 14, 2023

Plan of correction: Administrator agrees to complete an In Service Review with a sign in sheet with staff who are involved in making the decisions to retain, discharge or evict residents. Additionally, Administrator and staff will complete a statement of understanding by way of a LIC9098. Administrator agrees to submit Verification of the Inservice and LIC9098 form to community care licensing within the following business day.

Allegation investigated: Resident missed medical appointment resulting in requiring emergency treatment. Facility is allowing resident to leave unassisted. Facility staff not following physician's orders Facility not maintained clean and sanitary Resident's nutritional needs not met at facility Facility is not assisting resident with medical care

Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to deliver findings for the allegation(s) listed above. LPA met with the facility Care Coordinator, Araceli Soto and explained the purpose of the visit and the elements of the allegation. The allegation(s) were investigated and consisted of observations, interviews and records review. Regarding the allegation resident missed medical appointment resulting in requiring emergency treatment, it was alleged that Resident 1 (R1) missed several medical appointments resulting in R1 needing emergency treatment. R1 utilized and received services through a third-party transportation company. Facility staff are provided the transportation schedule. R1 requires medical treatments on Tuesdays, Thursdays and Saturdays. R1 had an appointment scheduled for 03/21/2020, however the third-party transportation never came to pick R1 up. A review of R1’s Post Treatment Form, dated 03/21/2020, corroborated the prescribed treatment was not given on this date. A review of R1’s Post Treatment Form, dated 03/24/2020, indicated R1 did receive the prescribed treatment on this second date. Unsubstantiated It was also alleged R1 missed a medical appointment on 02/26/2020. Interview with witness revealed R1 chose not to attend the medical appointment. A review of the Facility Shift Report dated 05/22/2020, the third party transportation company did not pick R1 up for a medical appointment. Facility staff denied R1 required or received emergency treatment for any of the missed medical appointments. However per Facility Shift Report dated 3/2/2020, R1 was sent out due to their wound bleeding excessively and leaking through the gauze. The department was not able to obtain corroborating documents regarding the emergency treatment either from witnesses or other third-parties. Therefore, this allegation is unsubstantiated at this time. Facility is allowing resident to leave unassisted It was reported that R1 was allowed to leave the facility unassisted when going to their medical appointments. R1 is ambulatory and per their physician’s reported dated 3/26/2020, R1 is unable to leave the facility unassisted. R1 did not have any reported eloping incidences and utilized a third-party transportation company to go to their appointments. An interview with the facility administrator revealed that there was a time when the third-party company was not coming inside to sign the residents out, the resident was not leaving unattended, as there was facility staff present in the lobby. This matter was addressed per the facility Administrator, as it was brought to the transportation company Director’s attention. After the matter was addressed, the third-party company staff would come inside the facility to pick up the residents. In addition, the facility policy is for all residents are to sign themselves in and out on the facility’s logbook. Based observation and interviews the allegation of facility is allowing resident to leave unassisted is unsubstantiated at this time. Facility staff not following physician's orders It was reported that R1 had a doctor’s order for wound care and that the ordered ointment was not being placed on the wound. Per the interview with the Administrator Ann Marie Santos. Ms. Santos stated that R1 had a diabetic wound which was not stageable and that have never been without home health. Ms. Santos stated that the diabetic wound has always been overseen by medical provider who provides R1 with a Home Health Nurse, who will come and place the ointment on the wound and are responsible for the care of the wound. Ms. Santos stated that the facility is not qualified to care for the wound due to it being a diabetic ulcer. Ms. Santos is not aware of R1 ever being without Home Health and was not aware that he ever missed the ointment being placed on the wound. In addition, Ms. Santos stated that R1 was sent out to the hospital in March because the wound was not healing even with the ointment being placed on the wound. Further included in the doctor’s order on around 3/25/20, The doctor ordered for R1 to be isolated at facility for a condition that was ***Continued on 9099C classified as "transferrable or contagious". During this time R1 did have a roommate, however It is important to note that during this time there was a pandemic and resources such as hospital beds were limited. The facility was encouraged to care for the resident at the facility as R1's condition at the time did not require hospitalization. It was further reported that facility staff also failed to follow universal precautions by not wearing gowns and masks while caring for resident. Per staff interviews conducted the proper protective equipment such as masks, gloves and gowns were worn when caring for R1. There was no evidence to corroborate what was alleged. Due to lack of evidence to show the alleged violation occurred the allegation of facility staff not following doctors orders is UNSUBSTANTIATED. Facility not maintained clean and sanitary It was reported that on or around March 2020, that there were feces on the door in R1’s room. Per the housekeeping staff, housekeeping services for R1 occurred daily. The services noted were daily trash pickup, towel change, toilet paper replenished, make or change bedding, vacuum, toilet, mirror, sink and polish. However, if there is an area that required cleaning that was not observed by housekeeping staff, it should be brought to the facility staff’ attention, so that the proper steps could be taken to address the area in need of cleaning. Per staff interviews R1 having feces on the door was something that occurred often, as it was a side effect that was experienced after R1 took their morning medication. If facility staff had knowledge of the area in need, then it would have been addressed. Based on interviews the allegation is UNSUBSTANTIATED. Resident's nutritional needs not met at facility. It was reported that R1 was being served only toast and an egg during breakfast. R1 is on a low carb diet, and would want items such as tater tots instead of the fruit that they were given. It was explained by the Administrator Ms. Santos and Chef to R1 as well as other relevant parties that because R1 is on a prescribed low carb diet, they will either be offered a small amount of the item served or an alternate altogether. Per the facility’s alternate menu for R1. R1 was served meals that were in accordance with suggested food guidelines, R1 was provided with fruits, vegetables, grains, protein and dairy. Based on interview and record review the allegation of resident nutritional needs not met at the facility is UNSUBSTANTIATED. ****Continued on 9099 C. Facility is not assisting resident with medical care. R1 received their medical services through a medical provider company. R1 had standing medical appointments three times a week. The facility staff would assist the resident with giving reminders for their upcoming appointments, and provide any updates that were provided to them. During an interview conducted with the Administrator Ms. Santos, R1 had a lapse in their insurance which in turn affected their services with the medical provided company. However, the facility nor was R1 responsible for their medical information. Once the individual responsible for R1’s medical information was made aware of the lapse in services, the issue was rectified and there were no further incidences, throughout the time of R1 being placed at the facility. R1 was noted to still receive services from Home Health. Based on interviews the allegation of facility is not assisting resident with medical care is Unsubstantiated. A finding of unsubstantiated means 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 a copy of this report was reviewed and provided to Araceli Soto.the state’s words, verbatim · CDSS document, Nov 27, 2023 · control 18-AS-20200406090857

Type of visit: Case Management - Incident

Licensing Program Analyst, Amber Coleman (LPA) arrived at the Montclair Royale Senior Living Facility unannounced to conduct case management visit in response to a recent death of a resident while in care of the facility. LPA was greeted by Administrative Assistant, Gwen Galvan and Care Coordinator, Araceli Soto. LPA was asked to signed in and met with Araceli Soto. LPA stated the purpose of the visit. During today's visit, LPA requested and collected pertinent documentation and conducted staff interviews to gather more information about the incident. On 11/8/23, Community Care Licensing, San Bernardino received an Incident Report, (SIR) notifying the agency of the death of a resident. No deficiencies was during today's visit. An exit interview was conducted where this report was discussed and provided to the Administrator.the state’s words, verbatim · CDSS document, Nov 17, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection LPA met with Facility Administrator AnnaMarie Santos and was granted entry to the facility. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (236) current census (129). LPA was accompanied by Facility Administrator, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected residents bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA measured and observed the water temperatures in the bathrooms to be at 115.8 degrees F The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for client/staff files. Medications are kept inside Med-Room inaccessible to residents. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed six (6) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed six (6) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator AnnaMarie Santos.the state’s words, verbatim · CDSS document, Oct 21, 2023

Allegation investigated: Illegal Eviction

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Montclair Royale Senior Living facility unannounced to deliver the findings of the complaint investigation. LPA met with Araceli Soto, introduced self and stated purpose of the visit. It is alleged that the resident was illegally evicted from the facility. Interviews with staff revealed that R1 moved in October 2023. During the period R1 was living at the facility, R1 had a number of occasions in which he violated the rules of the facility. The violations resulted in the facility issuing two evictions. One eviction was dropped due to R1’s enrolling into and participating in the PACE program. A second eviction notice was issued on 2/17/23 for violation of facility rules. This eviction notice provided incorrect contact information for the Long Term Care Ombudsman; deeming the eviction notice invalid. However, R1 moved out of the facility before the deadline of the eviction notice which was 3/18/23. Substantiated Based on staff interviews and record reviews, we have substantiated the complaint allegation(s) as valid and that a violation has occurred based on the preponderance of available evidence. A copy of this report along with appeal rights are being reviewed with and furnished to the facility representative. Please see LIC 9099D. A copy of this report along with appeal rights are being reviewed with and furnished to the facility representative.the state’s words, verbatim · CDSS document, Oct 16, 2023 · control 56-AS-20230420083238

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87224(C) · Plan of correction due date: Oct 16, 2023

87224 - Eviction Procedures (C)A statement informing residents of their right to file a complaint with the licensing agency... (a)(4), including the name, address and telephone number of the licensing office with whom the licensee normally conducts business, and the State Long Term Care Ombudsman office. This requirement was not met as evidenced by: Administrator failed to ensure the correct contact information for the Long Term Care Ombudsman was on the eviction notice. This posed a potential health, safety and/or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Oct 16, 2023

Plan of correction: Licensee/Administrator agrees to read and review the 87224 Evictions Procedures entirely. Also, send LPA a self-certified letter that the regulation was read, understood and will demonstrated in furture evictions. This form is to be submitted to the Community Care Licensing Office within 1 business day.

Allegation investigated: Staff does not ensure resident has access to resident's wheelchair. Staff does not ensure resident's room is clean and sanitary. Staff does not ensure resident's call light works.

Licensing Program Analyst, Amber Coleman, (LPA) made an unannounced visit to the Monclair Royale Senior Living Facility to deliver the findings of the complaint investigation. LPA met with Care Coordinator, Araceli Soto and stated the purpose of the visit. The investigation included interviews with staff and residents, a review of records and observations. It is alleged that staff does not ensure the resident has access to the resident’s wheelchair. Staff interviews revealed that R3’s wheelchair is kept in R3’s closet for the purposes of safety. During LPA’s visit, LPA made observation of R3’s room. LPA observed the wheelchair inside of the room outside of the closet. LPA accessed the wheelchair, opened it, pushed it, opened the foot pedals. The wheelchair appeared to be functional and in good repair. All staff report R3 has the ability to walk on their own on the floor. Photographic evidence depicted a wheelchair next to the resident’s bed, giving the resident access to the wheelchair. **Please see LIC9099-C Unsubstantiated It is alleged that staff do not ensure the residents’ room is clean and sanitary. During interviews with housekeeping staff, it was discovered that resident rooms are cleaned several times a week. For some residents this service is optional, while other residents’ rooms are routinely cleaned. During a visit to the facility, LPA observed a refrigerator with concerns for cleanliness, a water-stained ceiling tile. LPA also observed and later confirmed that R3 does not utilize the refrigerator in the room. The stained ceiling tile was replaced. All matters of concern were addressed at the time of the visit. It is alleged that staff do not ensure the resident’s call light works. During staff interviews and observations, LPA learned that when the call light is pulled, it notifies the staff in the office. Each time this occurs, office staff document when the call light was pulled, what room and what staff responded. LPA reviewed call light response logs for 5/4/23 through 5/8/23. No entry in the log indicated that a call light in the resident’s room was triggered. According to the facility’s maintenance logs, there is no indication that the call light is not functional. Based on information above, these allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means 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 with facility representative; this report was reviewed, discussed then provided.the state’s words, verbatim · CDSS document, Oct 16, 2023 · control 56-AS-20230503082338

Allegation investigated: Resident sustained an unexplained injury while in care of the facility. Resident wandered away from the facility due to staff neglect. Staff do not provide residents with daily activities. Staff do not provide accurate information needed to ensure resident is receiving appropriate care

Licensing Program Analyst, Amber Coleman, (LPA) arrived at the Montclair Royale unannounced to deliver findings of the complaint investigation into the allegations listed above. LPA introduced self and stated the purpose of the visit then discussed the findings. It is alleged that a resident sustained an unexplained injury while in care of the facility. Staff interviews revealed that R1 was scheduled for a dentist appointment at 8:30am. R1 had breakfast and left the facility at 6:40am via Innovage/PACE Transportation. Staff of Montclair Royale deny the incident occurred at the facility; reporting that no injuries were observed on R1 when she left for her appointment. Staff of Innovage reported that residents who arrive early to their appointments often wait at the Innovage Center in a courtyard unattended. It is unclear whether the lip injury occurred during her dentist appointment or possibly during her time in the courtyard at Innovage. Innovage staff investigated the matter and suggested the lip injury did not occur at Innovage due to lack of any incident report being submitted on or around the date of R1’s dentist appointment. LPA unable to reach R1’s family for interviews. Unsubstantiated It is alleged that resident wandered away from the facility due to staff neglect. LPA observed that R1 resides in the facility’s Memory Care Unit. The Memory Care Unit is a restricted unit in which staff need a key to enter and leave. A key is also required to use the elevator on the unit. During staff interviews, it was discovered that the memory care unit has an adequate amount of staff to care for the number of residents in care. Staff report that R1 did leave the memory care unit floor. R1 waited by the elevator, standing along side family members leaving the floor. The family didn’t know R1 was a resident of the memory care unit and allowed R1 to enter the elevator and leave floor. By all staff accounts, R1 did not leave the facility. R1 wandered around the first floor, never leaving the facility grounds. LPA unable to gather any information from R1 or family of R1. It is alleged that staff do not provide resident with daily activities. During LPA’s walkthrough of the facility, LPA observed a Large Print Activities Calendar posted in the hallway of the memory care unit. Accessible to all residents to read and join an activity. LPA also observed the dining room with different activity materials for crafting. Across from the dining room is an Activity Room with adequate seating. Staff report the room is used for group activities such as exercising or watching television. Resident are free to go in and out of the room as they please. This room included adequate seating as well as board and card games. LPA received a copy of the Memory Care Unit’s Activities Calendar which was consistent with observations. Staff interviews revealed that staff take turns throughout the day to lead activities. Staff encourage residents to participate, but participation is not mandatory. Staff report R1 may start an activity but may get distracted get up and leave. Staff allow residents to come and go to avoid aggressive or combative behaviors. It is alleged that staff do not provide accurate information needed to ensure resident is receiving appropriate care. Staff interviews revealed that R1 was taken to the hospital on two occasions. The first occasion was to address R1 injury. On the second occasion, R1’s daughter transported R1 to the hospital. A review of medical records and incident reports reflect that this occurred. Staff report that R1’s daughter was contacted to be notified of R1’s condition and current status but received no answer or returned call. On the second occasion, R1’s daughter was present during the hospital visit. Records also reflect ongoing communication between facility staff, R1’s daughter and Innovate staff. Innovage staff and R1’s daughter worked together to find better suited housing for R1 and closer to R1’s daughter. R1 officially moved out of the facility on 8/9/23. LPA was unable to reach R1’s daughter to obtain any other information or account of what occurred. Based on the information above, these allegations are UNSUBSTANTIATED. A finding of UNSUBSTANTIATED means 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 with facility representative and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 5, 2023 · control 56-AS-20230629154129

Type of visit: Case Management - Other

Licensing Program Analyst, Amber Coleman, (LPA) made an unannounced case management visit to deliver findings and obtain signatures for an amended report. LPA met with staff, introduced self and stated purpose of the visit. LPA obtained signatures and completed report. An exit interview was conducted where this report was discussed and provided to facility representative.the state’s words, verbatim · CDSS document, Oct 5, 2023