197608401-3-21-2022-28-AS-MVAO-CECSB2-20220512134312

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 03/21/2022
Date Signed: 03/21/2022 12:11:38 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
03/18/2022 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220318101341

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:	03/21/2022
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Peter Babaian -Adminsitrator		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Staff are not providing adequate food service for residents
Staff are not properly sanitizing dishes

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong conducted an unannounced complaint visit to investigate the above allegations. LPA met with LVN-Amy Smbatuni and explained the reason of the visit. Shortly after, the administrator Peter Babaian arrived.

The investigation consisted of the following: LPA toured the kitchen and dining room. LPA interviewed six (6) residents (R1-R6) and administrator and four (4) staff (S1-S4) and obtained copy of the resident and staff roster and the menu for the week.

The investigation revealed of the following: Allegation#1 "Staff are not providing adequate food service for residents." LPA interviewed six (6) residents and five (5) residents reported they always get enough food in the facility. They can have second plate if they want and they can get substitue choices if they do not like the food on the meun of the day. They were never being hungry or starving in the facility.
(See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022

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-20220318101341

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: 03/21/2022

NARRATIVE

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Five (5) residents also reported they never experienced any shortages of dishes. LPA also toured the kitchen and observed there's at least two days perishable and seven days non-perishable food supply in the facility. Staff also reported no resident ever complained there's an inadequate food service in the facility. Staff stated that they always have sufficient food supply in the facility. LPA also toured the facility basement and kitchen, and observed there are sufficient plates, cups or utensils in the kitchen. And there are also additional brand new plates and disposable cups and plates in the basement.

Allegation#2 "Staff are not properly sanitizing dishes" LPA interviewed six (6) residents and five (5) residents stated that all the plates, cups and dishes in the facility are clean. They never came across with the dishes in the facility are not clean. LPA also interviewed staff and staff reported they would rinse all the dishes with soap first and then put into the dishwasher for additional cleaning. Staff reported no resident ever complained the dishes are not clean in the facility. And they would not allow anything happened like that too.

Based on interviews conducted with facility staff, facility residents and LPA observations, there was not enough supportive evidence to concur with the reported allegations.

Although the allegations 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 allegations are UNSUBSTANTIATED.

Exit interview held. A copy of the report and appeal right was provided to Administrator Peter Babaian.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 03/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/21/2022

LIC9099 (FAS) - (06/04)

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