197608401-2-15-2022-28-AS-SCOL-CDHUL7-20220415154015

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 02/15/2022
Date Signed: 02/15/2022 12:33:56 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
02/08/2022 and conducted by Evaluator David Sicairos

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220208095038

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:	02/15/2022
		UNANNOUNCED	TIME BEGAN:	10:50 AM
MET WITH:	Peter Babaian; Administrator		TIME COMPLETED:	12:40 PM

ALLEGATION(S):

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Facility administration is telling the resident he has to change his insurance to their insurance.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegation. LPA met with Peter Babaian and explained the reason for the visit.

The investigation consisted of the following: LPA obtained copies of Staff and Resident Rosters. LPA also reviewed Resident #1 (R1's) file and obtained copies of the following documents: Copy of Insurance Card, Physician's Report, ID Emergency Information, Resident Appraisal, and Needs & Services Plan. LPA also interviewed Staff #1 - Staff # 2 and Resident #1 (R1) - Resident #5 (R5).

The investigation revealed the following: in regards to the allegation "facility administration is telling the resident he has to change his insurance to their insurance", it is alleged that facility administrators are telling a resident that he must change his insurance to the facility insurance company. It is alleged that this resident would lose his dental and vision insurance if the change is made and would have to pay out of pocket expenses to see his doctors.

(CONTINUED ON 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

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-20220208095038

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: 02/15/2022

NARRATIVE

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Interviews conducted with staff members all denied the allegation. Staff indicated that the facility does not offer their own insurance. Facility staff indicated resident could have possibly misunderstood staff. Staff provided different insurance options to resident to better serve their specific needs, however no changes have been made to any residents insurance coverage. LPA also spoke to resident in question who confirmed that facility staff have not made any changes to his insurance coverage. All staff members interviewed indicated that they are not forcing any resident to make changes to their insurance coverages. 5 out of 5 residents interviewed indicated that facility staff have not forced them to make any changes to their insurance coverage. Therefore there was insufficient evidence to corroborate with this allegation.

Based on statements and interviews conducted with staff, clients, review of resident files and facility file records, there was not enough supportive evidence to concur with the reported allegation. 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.

Exit interview held, and a copy of this report was provided.

SUPERVISOR'S NAME: Stefanie Coronel	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: David Sicairos	TELEPHONE: (323) 981-3982
LICENSING EVALUATOR SIGNATURE:	DATE: 02/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022

LIC9099 (FAS) - (06/04)

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