197608401-8-17-2022-28-AS-MVAO-CJ9TWT-20220914150604

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 08/17/2022
Date Signed: 08/17/2022 01:57:35 PM

Substantiated

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
08/10/2022 and conducted by Evaluator Angelica Rea

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220810083632

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:	08/17/2022
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Peter Babaian		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility is not properly addressing insect issue

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Angelica Rea conducted a visit in response to the above allegation. On today's visit, LPA met with Administrator, Peter Babaian who assisted with today's visit.

Regarding the allegation that the facility is not properly addressing insect issue, the investigation consisted of: Interview(s) with Administrator, Staff #1, Resident #1 - Resident #5, tour of facility, and review of pest control invoices. LPA also spoke to LA County Public Health Environmental Health Specialist regarding recent visit to the facility. Administrator stated that none of the residents have stated there was a problem with bed bugs. He said that the facility has a contract with a pest control service, and they come to the facility twice per month. He said that following the LA County Public Health visit, the facility has had (2) visits from the Pest Control service on 8/12/22 and 8/16/22, to address the bed bug issue. Administrator provided copies of reports from the visits. LPA observed that the reports indicated that the following rooms were treated for bed bugs: Rooms 10 and 12 in the main building, and Bungalow 1511 Rooms #1 - Room #5. Staff #1 stated that she toured the facility with LA County Public Health and also observed bed bugs in Bungalow 1511, Rooms #1- #4. Staff #1 stated that they treated Room #5 in Bungalow #1511 as a precaution.

Substantiated

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: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 28-AS-20220810083632

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: 08/17/2022

NARRATIVE

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LPA did not observe bed begs in the rooms toured on today's visit. LPA observed 3 cockroaches crawling in the door frame of bathroom in Room #2. Staff #1 also observed the cockroaches and asked the facility maintenance person to spray the area.

Residents interviewed were unable to corroborate the allegation. Four out of five residents interviewed stated that they have not observed bed bugs or cockroaches at the facility.

Based on record review and interviews conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Deficiencies are being cited according to California Code of Regulations, Title 22 and Health and Safety Code.

An exit interview was conducted with Mr. Babaian. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20220810083632

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/17/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 08/24/2022 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee shall provide proof of treatment of bed bugs and cockroaches and plan to prevent the pests from spreading in the facility. The proof shall be submitted to LPA Rea by POC due date of 8/24/22.
	8 9 10 11 12 13 14	Based on interviews and documents reviewed, bed bugs and cockroaches were recently observed at the facility, which poses a potential health and safety risk to residents in care. LPA observed cockroaches in Room #2 bathroom on today's visit.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Lisa Hicks	TELEPHONE: (323) 981-3972
LICENSING EVALUATOR NAME: Angelica Rea	TELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:	DATE: 08/17/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/17/2022

LIC9099 (FAS) - (06/04)

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