197608401-11-4-2021-28-AS-FFIS-CDXV7N-20220429161123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 11/04/2021
Date Signed: 11/04/2021 02:45:33 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
10/27/2021 and conducted by Evaluator Jose Villalobos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211027104935

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:	11/04/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Administrator Peter Babaian		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff left resident in soiled clothing for an extended period of time.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint visit to address the above allegations. LPA met with Administrator Peter Babaian. The purpose of the visit was discussed.

The investigation consisted of the following: On today's visit, LPA toured the physical plant, interviewed residents #1-#7 (R1-R7), and interviewed Staff #1-#6 (S1-S6). LPA also reviewed R1's facility file.

The investigation revealed of the following: In regards to the allegation, "Staff left resident in soiled clothing for an extended period of time." it was alleged that on 10/23/21, it was observed that R1's diaper had not been changed and was left with soiled clothing. (6) of (6) staff interviewed denied the allegation. (7) of (7) clients interviewed could not corroborate the allegation. Interviews with staff show that R1 does wear a diaper but as a personal choice. Interviews state that R1 is able to use the restroom and staff frequently ask R1 if they would like assistance but R1 prefers to be in a diaper and use it instead of getting out of bed.

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

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-20211027104935

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: 11/04/2021

NARRATIVE

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Staff interviews do not show that R1 is left in soiled clothing and that staff do change resident clothing daily. R1 refused to be interviewed on todays visit. Review of R1's file does not show that R1 needs assistance with their toileting needs and their plan of care does not show that a diaper is necessary. Based on statements and interviews conducted with staff and clients as well as LPA observation, there was not enough supportive evidence to concur with the reported allegation. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted with Administrator Peter Babaian. A copy of this report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Jose Villalobos	TELEPHONE: (323) 980-4939
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

LIC9099 (FAS) - (06/04)

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