197608401-8-5-2022-28-AS-MVAO-CHERCY-20220818125506

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 08/05/2022
Date Signed: 08/05/2022 03:11:44 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
09/09/2020 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200909154000

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:	08/05/2022
		UNANNOUNCED	TIME BEGAN:	11:34 AM
MET WITH:	Peter Babaian- Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff failed to prevent resident from AWOL’ing from facility.
Staff is admitting residents who need a higher level of care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) V. Maldonado made a subsequent unannounced complaint visit at the facility regarding the above mentioned allegations. LPA Maldonado met with assistant Administrator Alise Nazarian and Administrator Peter Babaian, and explained the purpose for the visit.

During today's visit, LPA Maldonado toured the physical plant with assistant administrator Alise Nazarian. A copy of the resident and staff roster were requested, as well as a copy of the following documents for Resident# 1 (R1): Admission's agreement, Physician's report, identification and emergency information, Preplacement Appraisal, Needs and Services Plan, Medication Administration Records (MARs) for September 2020, and the Plan of Operations- Absentee Notification Plan for Missing Residents. Administrator, assistant adminstrator, Staff# 1 (S1), and Residents# 2-6 (R2-R6) were also interviewed.

Report Continued on LIC9099-C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022

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-20200909154000

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: 08/05/2022

NARRATIVE

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Allegation- Staff failed to prevent resident from AWOL’ing from facility.
During interviews conducted with administrator, assistant administrator, and S1, (3) of (3) staff state that the majority of the residents are allowed to leave the facility unassisted. The residents who require assistance are transported in the facility vehicle by staff or by their responsible parties. Staff interviewed stated they did not fail to prevent residents from AWOL'ing from the facility. After review of R1's records, it was discovered that R1 was able to leave the facility unassisted, per R1's physician's report. After review of the facility's Plan of Operations, it was discovered that the policy indicates that all residents are encouraged to sign out and sign in upon their return at the log that is kept at the reception desk. During interviews conducted with R2-R6, (5) of (6) residents state they are aware of the facility policy to report anytime they leave/return to the facility.

Allegation- Staff is admitting residents who need a higher level of care.
During interviews conducted with administrator, assistant administrator, and S1, (3) of (3) staff stated all residents, prior to being admitted to the facility, go through a series of evaluations and interviews to determine compatibility with current residents and the care needs that the facility provides, per the facility's Plan of Operations- Intake Procedure for Placement in an RCFE. Staff interviewed stated they do not admit residents who need a higher level of care. During interviews conducted with R2-R6, it was stated that (6) of (6) residents feel that the facility has compatibility between current residents and their care needs. Residents interviewed stated that all staff assist them with their needs. After review of C1's records, it was discovered at C1 met the criteria stated in the intake procedure for placement at the facility, per the facility's plan of operations.

Based on interviews, observations, and record reviews, 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 allegation is UNSUBSTANTIATED.

An exit interview was conducted with administrator Peter Babaian and a copy of the report was provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Valeria Maldonado	TELEPHONE: 323-981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2022

LIC9099 (FAS) - (06/04)

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