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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 02/21/2021
Date Signed: 02/22/2021 11:20:57 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/23/2020 and conducted by Evaluator Linda M Almaraz
COMPLAINT CONTROL NUMBER: 28-AS-20200623152228
FACILITY NAME:VICTOR ROYALE, LLCFACILITY NUMBER:
197608401
ADMINISTRATOR:PETER BABAIANFACILITY TYPE:
740
ADDRESS:120 E. LAUREL STREETTELEPHONE:
(818) 243-7442
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:60CENSUS: 54DATE:
02/21/2021
UNANNOUNCEDTIME BEGAN:
02:00 AM
MET WITH:Administrator, Peter BabaianTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff are locking the main entrance door
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Linda Almaraz conducted a subsequent complaint tele-visit investigation for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, this complaint investigation was conducted telephonically with Peter Babaian, Administrator.

The investigation consisted of the following: On 6/30/20, LPA Almaraz conducted interviews with Administrator and Staff #1-4. LPA requested copies of: Staff and Resident Roster, Staff schedule/time sheets.

The investigation revealed the following:Per interviews conducted, the staff was locking the facility doors so the residents do not leave when there is not any staff in the front desk.

***Continued on LIC 9099C***
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M AlmarazTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2021
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 3
Control Number 28-AS-20200623152228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: VICTOR ROYALE, LLC
FACILITY NUMBER: 197608401
VISIT DATE: 02/21/2021
NARRATIVE
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Per Staff #1, on 6/28/20 the staff working the night shift had locked the front door because there was only 2 staff at night and one of them needed assistance with a resident. Interviews revealed the staff locked the door and they left it locked all night. In the morning the Glendale Fire Department arrived and were unable to enter the building. On 6/29/20, Community Care Licensing (CCL) received photos of the facilities doors being locked with a black cable that had a key lock. Interviews conducted revealed the doors were being locked because they did not want the residents to leave the facility due to the Coronavirus Disease.

Based on interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated.

One Deficiency cited under California Code of Regulations Title 22

An exit Interview was conducted via telephone with the Administrator and a hardcopy was provided via email for signature. Appeal Rights was provided.

SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M AlmarazTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20200623152228
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VICTOR ROYALE, LLC
FACILITY NUMBER: 197608401
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/21/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/22/2021
Section Cited
CCR
87468.1(a)(6)
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87468.1 Personal Rights of Residents in All Facilities. (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (6) To leave or depart the facility at any time and to not be locked into any room, building, or on facility premises by day or night.....
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Administrator shall ensure the doors are not locked. Licensee agreed to read Title 22, Section 87468.1 and send a written statement that he read it and will abide in the regulations.
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This requirement is not met as evidence by: Based on interviews conducted and photos received. The facility was locking the front doors with a black cable with a lock, preventing the residents from leaving the facility.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Linda M AlmarazTELEPHONE: (323) 981-3307
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3