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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 06/30/2022
Date Signed: 06/30/2022 02:36:34 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
06/28/2022 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220628163253
FACILITY NAME:VICTOR ROYALE, LLCFACILITY NUMBER:
197608401
ADMINISTRATOR:PETER BABAIANFACILITY TYPE:
740
ADDRESS:120 E. LAUREL STREETTELEPHONE:
(818) 243-7442
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:60CENSUS: 53DATE:
06/30/2022
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Peter Babaian TIME COMPLETED:
03:00 PM
ALLEGATION(S):
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9
Staff hit resident
Staff handled resident in a rough manner
Resident sustained injuries while in care
Staff threatened residents
Staff made inappropriate comments towards resident
Staff did not safeguard residents personal belongings
INVESTIGATION FINDINGS:
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On the above date, Licensing Program Analyst (LPA) Christine Wong conducted an intiail 10 days complaint which included the 24 hours healthy and safety check. LPA met with Assistant Administrator Alise Nazarian and explained the reason of the visit and she also assisted LPA with the visit.

The investigation consisted of the following: A physical plant tour of the facility was conducted. No health and safety issues were observed. LPA also interviewed seven residents (R1-R7), administrator and five staff (S1-S5) and also obtained copy of residents roster, staff roster and incident report for R1 and reviewd the residents' diaper changing log book

The investigation revealed of the following: Allegation#1 " Staff hit resident." LPA interviewed seven residents and six out of seven residents denied the allegation and reported they never seen any staff hit resident. LPA interviewed the victim and also denied any staff was hitting him in the facility and reported it never happened.
(See LIC 9099C for continuation)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
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 6
Control Number 28-AS-20220628163253
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: 06/30/2022
NARRATIVE
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LPA also interviewed staff and all denied the allegation and stated that if its really happened. They would report it immediately. Based on interviews and observations, although the allegation 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

Allegation#2 "Staff handled resident in a rough manner" LPA interviewed seven residents and five out of seven residents denied the allegation and reported staff never handled them on a rough manner and pushed them hard. LPA interviewed six staff and all denied the allegation and reported no resident ever complained staff handled them roughly and also they never seen any staff handled resident in a rough manner. Administrator also reported that staff received training on how to handle resident. Staff also reported they would never force any resident to take the medication and its violating the human right. If resident refused to take the medication, they would just report it to their primary physician. Based on interviews and observations, although the allegation 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

Allegation#3 "Resident sustained injuries while in care" LPA interviewed seven residents and six out of seven residents denied the allegation and reported they never had any injury or sustained any injury in the facility. The victims also reported they never got any head or eye injury or any scratches from the staff. LPA also did not observe any residents had any scratches on their face. LPA interviewed staff and also denied the allegation and reported there's no incident reported or filed lately because of residents had or sustained any injuries. Based on interviews and observations, although the allegation 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

Allegation#4 "Staff threatened residents" LPA interviewed seven residents and four out of seven residents denied the allegation and reported staff never threatened them. Staff are nice to them and they never did that to them or other residents. LPA interviewed staff and they all denied the allegation and reported they never heard any staff threatened residents or no residents ever complained staff threatened them. They are all happy with the staff. Based on interviews and observations, although the allegation 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

.
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20220628163253
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: 06/30/2022
NARRATIVE
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Allegation#5 "Staff made inappropriate comments towards resident" LPA interviewed seven residents and six out of seven residents denied the allegation and reported the staff are nice to them and respectful to them. LPA interviewed staff and denied the allegation and reported the administrator are very strict on that and very on top of it. The staff also never witnessed any staff made inappropriate comments to residents. Based on interviews and observations, although the allegation 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

Allegation#6 "Staff did not safeguard residents personal belongings" LPA interviewed seven residents and four out of seven residents denied the allegation and reported they never lost anything in the facility. LPA interviewed the staff and staff reported that they would send two staff to assist resident to search their rooms. Sometimes it may be under their bed, pillow or in the drawer. Staff also stated that its clothes items and they maybe in the laundry room. Based on interviews and observations, although the allegation 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

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was conducted with Peter Babaian and a copy of this report and appeal rights provided.
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
06/28/2022 and conducted by Evaluator Christine Wong
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220628163253

FACILITY NAME:VICTOR ROYALE, LLCFACILITY NUMBER:
197608401
ADMINISTRATOR:PETER BABAIANFACILITY TYPE:
740
ADDRESS:120 E. LAUREL STREETTELEPHONE:
(818) 243-7442
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:60CENSUS: 53DATE:
06/30/2022
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Peter Babaian TIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
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8
9
Staff left resident in soiled diaper for extended period of time
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On the above date, Licensing Program Analyst (LPA) Christine Wong conducted an intiail 10 days complaint which included the 24 hours healthy and safety check. LPA met with Assistant Administrator Alise Nazarian and explained the reason of the visit and she also assisted LPA with the visit.

The investigation consisted of the following: A physical plant tour of the facility was conducted. No health and safety issues were observed. LPA also interviewed seven residents (R1-R7), administrator and five staff (S1-S5) and also obtained copy of residents roster, staff roster and incident report for R1 and reviewd the residents' diaper changing log book

The investigation revealed of the following: Allegation "Staff left resident in soiled diaper for extended period of time" LPA interviewed seven residents and four out of seven reported they always got soiled diaper for extended period of time. Residents reported staff only changed them twice or three times a day.
(See LIC 9099C for contination)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 28-AS-20220628163253
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: 06/30/2022
NARRATIVE
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Residents reported their diapers always got wet and soiled and staff did not come and change them on time. LPA also review the residents' diaper changing log book and indicated some residents did not get diaper change after 6 hours or only twice a day.

Based on LPA's record review and interview, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 and Chapter 1 are being cited on the attached LIC 9099D.

Exit interview conducted with Victor Mora and a copy of this report and appeal rights provided.
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20220628163253
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: 06/30/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/14/2022
Section Cited
CCR
87625(b)(2)
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87625 Managed Incontinence (b)the licensee shall be responsible for the following:(3)(3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. The requirement is not met as evidenced by:
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The administrator will ensure the incontience residents are kept clean and dry and will send a plan how to make sure residents would not have soiled or wet diaper for extended long period of time.
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LPA interviews and 4/7 residents reported they always got soiled or wet diaper and record review. Some residents only got changed twice a day
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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: Christine YeeTELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6