197608401-4-14-2022-28-AS-MVAO-CDNQ9B-20220420115803

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 04/14/2022
Date Signed: 04/14/2022 02:42:25 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
12/18/2020 and conducted by Evaluator Nune Margaryan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20201218154545

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: 54	DATE:	04/14/2022
		UNANNOUNCED	TIME BEGAN:	01:30 AM
MET WITH:	Administrator Peter Babaian		TIME COMPLETED:	02:40 PM

ALLEGATION(S):

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Staff handled a resident inappropriately
Staff locked a resident in the patio
Staff did not intervene during resident to resident conflict
Staff do not safeguard table setting for residents in dining room
Staff are interfering with resident phone calls

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nune Margaryan conducted a subsequent complaint visit to deliver findings on the allegations listed above. LPA met with administrator Peter Babaian and explained the purpose of today's visit.
An initial 10-day telephonic complaint visit was conducted on 12/28/2020 by Licensing Program Analyst (LPA) P. Rivas.
A subsequent complaint visit was conducted on 12/10/2021 by LPA N. Margaryan. During the visit LPA Margaryan conducted interviews with the administrator, facility staff and residents regarding the allegations listed above.

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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 04/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2022

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-20201218154545

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: 04/14/2022

NARRATIVE

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The investigation revealed the following:
Regarding the allegations of Staff handled a resident inappropriately and Staff locked a resident in the patio. It was reported that Resident 1 (R1) observed Staff 3 (S3) and Staff 1 (S1) threaten to lock Resident 2 (R2) in the patio if R2 refused to shower. It was also reported that R1 also observed S3 lock R1 out, causing S1 to argue with S3 regarding S1’s actions. R2 began to bang on the door at which time S3 unlocked the door. During the investigation interviews were conducted with R1, R2, S1 and S3. When interviewed R1 could not confirm if such an incident occurred, R2 denied he was locked in the patio. S3 denied locking R2 or any other resident in the patio and S1 denied witnessing R2 being locked in the patio by the S3 or any other facility staff. Based on the information obtained the allegation is Unsubstantiated at this time.

Regarding the allegation of Staff did not intervene during resident to resident conflict. It was reported that sometime in December 2020 there was an incident with Resident 3 (R3) yelled at Resident 1 (R1) because R3 wanted to use the phone when it was being used by R1. It was also reported that R3 walked aggressively towards R1 and grabbed the phone from him which was observed by the S3. During the investigation interviews were held with the S3, R1 and R3. When interviewed R1 could not recall such an incident occurred but did state that R3 tries to restrict him from using the facility phone, however when interviewed R3 denied such an incident occurred and denied bothering/restricting anyone from using the facility phone. S3 also denied witnessing such an incident. Based on the information obtained the allegation is Unsubstantiated at this time.
Regarding the allegation of Staff do not safeguard table setting for residents in dining room it was reported that staff allow other residents to remove the utensils from the table which prevents R1 from sitting at his usual table. During the investigation interviews were conducted with the facility administrator, staff, R1 and other facility residents. When interviewed R1 was questioning why he is unable to sit at his usual table during dinner. According to the administrator other residents do not want to dine or interact with R1 due to his hygiene and the staff cannot force the residents to do so. Other residents interviewed did not report concerns about not having utensils or having any problems with the dining. Based on the information obtained the allegation is Unsubstantiated at this time.
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SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20201218154545

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: 04/14/2022

NARRATIVE

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Regarding the allegation of Staff are interfering with resident phone calls it was reported that facility administrator angrily held a discussion with R1 about his phone use and that facility residents are limited now to 5 minutes on the phone. During the investigation interviews were conducted with the administrator, staff, R1 and other facility residents. When interviewed administrator denied speaking with R1 angrily about phone use or at any time. Administrator and all staff denied interfering with resident phone calls or allowing residents only 5 minutes to use the phone. When interviewed all residents except R1 denied staff interfering with their phone calls or only being allowed to use the phone for 5 minutes or any specific minutes. Based on the information obtained the allegation is Unsubstantiated at this time.

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.

Exit interview held and a copy of the report was provided to Administrator.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3378
LICENSING EVALUATOR NAME: Nune Margaryan	TELEPHONE: 323-981-3378
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022

LIC9099 (FAS) - (06/04)

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