197608401-5-4-2022-28-AS-LHIS-CEHN5K-20220517100941

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 05/04/2022
Date Signed: 05/04/2022 01:53:40 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
04/29/2022 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220429103611

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: 55	DATE:	05/04/2022
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Peter Babaian		TIME COMPLETED:	12:45 PM

ALLEGATION(S):

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Facility refused to comply with resident's physician report
Staff spoke to resident inappropriately

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint visit in response to the above allegations. LPA met with Administrator, Peter Babaian who assisted with today's visit.

Regarding the allegation that the facility refused to comply with resident #1's physician's report, the investigation consisted of Review of Resident #1's physician report, and Interview(s) with Administrator, Staff #1, Staff #2, and Resident #1 - Resident #5. Administrator and Staff interviewed stated that resident #1 resides in a cottage which is located behind the main building. Administrator and staff interviewed stated that the cottages are for ambulatory residents. Staff stated that resident #1's physician report dated 4/19/22 states that he is ambulatory, however he has been using a walker for the last couple of months due to reduced mobility. Staff indicated that they would prefer resident #1 move to the main building for his safety. However, they are not going to move resident #1 against his will.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

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-20220429103611

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: 05/04/2022

NARRATIVE

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Regarding the allegation that staff #1 spoke to resident inappropriately, the investigation consisted of Interview(s) with Administrator, Staff #1, Staff #2, and Resident #1 - Resident #5. Administrator and staff interviewed denied the allegation. Staff #1 stated that she did not speak to resident inappropriately. Staff #2 stated that she was a witness to the conversation between Resident #1 and Staff #1, and denied that Staff #1 spoke inappropriately to resident. Residents interviewed were unable to corroborate the allegation. They stated that staff do not speak to residents inappropriately.

Based on LPA's observations and interviews, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. Exit interview conducted, and a copy of report was provided to Administrator, Peter Babaian.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 05/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2022

LIC9099 (FAS) - (06/04)

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