197608401-9-2-2022-28-AS-RORN-CJVV7X-20221004161152

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 09/02/2022
Date Signed: 09/02/2022 12:02:09 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
08/26/2022 and conducted by Evaluator Elizabeth Irra

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220826152859

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:	09/02/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Alise Nazarian and Peter Babaian		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff member yells at residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Elizabeth Irra conducted an intial 10-day complaint visit to investigate the above allegation. LPA met with Alise Nazarian (Assistant Administrator) and discussed the purpose of today's visit. Peter Babaian (Facility Administrator) arrived at approximately 10:10 A.M..

During this investigation, LPA ontained a copy of the staff roster, resident roster, sign-in sheet for resident rights/bullying training (dated 08/08/22), a letter dated April 27, 2022 issued to S-4 (written warning) and reviewed S-4's file . LPA interviewed the Assistant Administrator, Facility Administrator, Staff #1 through Staff # 4 (S-1 through S-4) and interviewed Resident #1 through Resident #5 (R-1 through R-5).

Refer to LIC 9099C for the continuation of this report.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022

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-20220826152859

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: 09/02/2022

NARRATIVE

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Allegation: Staff member yells at residents. (4) ouf of (6) interviewed staff indicated they have either witnessed or have received reports in regards to S-4 yelling at residents. Facility Administrator indicated S-4 was given a written warning in regards to S-4's behavior (verbal abuse) and tardiness on April 27, 2022. (2) out of (6) interviewed staff indicated S-6 does not yell and is "just loud". (4) out of (5) interviewed residents indicated S-4 yells at residents. Staff and resident interviews corroborates this allegation.

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.

Exit interview conducted, a copy of Appeal Rights and a copy of this report was provided to Peter Babaian.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220826152859

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: 09/02/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 09/05/2022 Section Cited CCR 87468.1(a)(1)	1 2 3 4 5 6 7	Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff, residents, and other persons. This standard is not met as evidence by: (4) ouf of (6) interviewed staff indicated they have either	1 2 3 4 5 6 7	Facility Administrator provided staff training on Resident Rights on 08/08/2022 (copy provided). Facility Administrator to provide a written statement in regards to actions that will be taken pertaining to S-6. Written statement to be provided to LPA Irra by POC due date.
	8 9 10 11 12 13 14	witnessed or have received reports in regards to S-6 yelling at residents. (4) out of (5) interviewed residents indicated S-6 yells at residents.	8 9 10 11 12 13 14	Civil Penalties issued (repeat violation).
	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: Christine Yee	TELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth Irra	TELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:	DATE: 09/02/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2022

LIC9099 (FAS) - (06/04)

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