197608401-12-10-2021-28-AS-CYEE-C9U9BC-20211218221320

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 12/09/2021
Date Signed: 12/10/2021 07:35:12 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
07/15/2021 and conducted by Evaluator LaJean Nicole Spencer

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20210715162136

FACILITY NAME:	VICTOR ROYALE, LLC		FACILITY NUMBER:	197608401
ADMINISTRATOR:	PETER BABAIAN		FACILITY TYPE:	740
ADDRESS:	120 E. LAUREL STREET		TELEPHONE:	(818) 243-7442
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91205
CAPACITY:	60	CENSUS: 56	DATE:	12/09/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Peter Babaian, administrator		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Resident changed another resident's diaper while in care
Facility has inadequate record keeping
Staff are not meeting the diapering needs of the residents
Staff did not prevent a resident on resident altercation

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicole Spencer conducted a subsequent complaint visit regarding the allegations listed above. LPA Spencer was met by administrator Peter Babaian and explained the purpose of today's visit.

The investigation consisted of the following: During the initial visit on 7/20/21, LPA Spencer took a tour of the physical plant and interviewed the administrator, staff #1-4 (S1-S4) and residents #1-6 (R1-R6). LPA attempted to interview S5 but was unable to be reached and R2 was non-verbal so the interview was discontinued. LPA received copies of the staff roster, resident roster, and diapering logs for three (3) specified residents. During today's visit on 12/9/21, LPA Spencer interviewed staff #6 (S6), resident #7-9 (R7-R9), and collected copies of needs and services plan for two specified residents.

***See LIC9099C for continuation of this narrative***

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210715162136

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: 12/09/2021

NARRATIVE

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The investigation revealed the following:
Resident changed another resident's diaper while in care
It was alleged that a resident changed another resident’s diaper due to staff not changing the resident’s diaper in a timely manner. Seven (7) out of eight (8) residents interviewed stated that they did not know of any incident like this. One (1) resident stated that resident R6 kept screaming in the middle of the night for staff to change the diaper, so the resident changed R6's diaper. R6 denied this, stating only staff have changed R6's diaper. All staff interviewed denied the allegation with one (1) staff stated that they were told by a resident that this happened but did not witness it or know if it's true.

Facility has inadequate record keeping

It was alleged that staff are not maintaining adequate records including diapering logs. LPA obtained a copy of diapering logs for 3 specified residents. Diapering logs included the date, time, and initial of staff that conducted the diaper change. LPA observed that the logs were maintained daily and logs indicated that diapering took place for residents throughout the day. Interviews with staff reveal that four (4) out of six (6) staff stated that record keeping of diapering was maintained, while two (2) out of six (6) stated that it was not maintained accurately by all staff. Residents interviewed were not aware of this.

Staff are not meeting the diapering needs of the residents

It was alleged that staff are not changing resident’s diapers when needed at each shift. A review of the diaper logs for 3 residents shows that diaper change logs are filled out and completed throughout the day. The administrator stated that diaper checks are done every 2 hours and residents are changed as needed. Staff on each shift are responsible to check and change diapers. Four (4) out of six (6) staff interviewed stated that all staff meet the diapering needs of residents, one (1) out of six (6) stated diapering needs were not met by nighttime staff, while one (1) was unsure regarding this issue. Four (4) out of eight (8) residents interviewed stated that their diapering needs are met, three (3) out of eight (8) stated that their diapering needs are not met at night, and one (1) was unsure and does not wear diapers. A review of the needs and services plans for the residents who stated that their diapering needs are not met show that they are continent and able to use the restroom on their own.

***Continued on LIC9099C***

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20210715162136

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: 12/09/2021

NARRATIVE

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Staff did not prevent a resident on resident altercation

It was alleged that on 7/13/21, two (2) residents had a verbal altercation and staff did not intervene when informed by another resident about the incident. Interviews with residents reveal: one (1) out of (8) eight residents stated that staff did not intervene during the resident altercation, one (1) stated that staff sometimes intervene, while six (6) out of eight (8) residents interviewed stated that they were not aware of this incident but that staff do intervene during resident altercations. The two (2) residents allegedly involved in the altercation did not recall the incident. Four (4) out six (6) staff were not aware of this incident but state that staff do intervene in resident altercations, while two (2) out of six (6) staff stated that staff went to check on the residents but it had already de-escalated and did not develop into a serious incident.

Based on interviews and records reviewed, although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with the administrator, and a copy of this report and appeal rights provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: LaJean Nicole Spencer	TELEPHONE: (323)981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 12/09/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2021

LIC9099 (FAS) - (06/04)

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