197608401-12-22-2021-28-AS-FFIS-CK7MAL-20221014092629

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 12/22/2021
Date Signed: 12/22/2021 03:58:26 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
12/09/2021 and conducted by Evaluator Nina Galarza

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20211209150317

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: 53	DATE:	12/22/2021
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:			TIME COMPLETED:	04:15 PM

ALLEGATION(S):

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Resident was pushed by another resident.
Staff allow residents to smoke inside the facility.
Resident was not accorded a healthful accommodation

INVESTIGATION FINDINGS:

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12/22/2021 Licensing Program Analyst (LPA) Nina Galarza conducted an unannounced subsequent visit regarding the allegations listed above. LPA met with staff, Amy Smbatuni and stated the purpose of the visit. LPA later met with Administrator Peter Babaian and stated the purpose of the visit. On 12/15/2021 LPA toured the facility with Staff#1(S1).

The investigation consisted of the following; On 12/15/2021, interviews with Administrator, Staff #1-5(S1-S5) and Residents #1-5(R1-R5). On 12/15/2021 LPA obtained copies of staff roster, resident roster, face sheet for R1-R5, admission agreement and house rules. On 12/22/2021, interviews with Administrator and R1- R5. On 12/22/21 LPA obtained copies of staff roster, resident roster, facility sketch, and notice of construction.

CONTINUED 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Nina Galarza	TELEPHONE: 323-981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

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-20211209150317

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: 12/22/2021

NARRATIVE

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In regards to the allegation: "Staff allow residents to smoke inside the facility." On 12/15/21 Administrator was interviewed and denied the allegation. On 12/15/2021, S1-S5 were interviewed, (3) out of (5) staff denied the allegation and stated they would tell the Administrator if they were to see a resident smoking in their room. On 12/15/2021 R1-R5 were interviewed, (4) out of (5) residents stated they do not smoke in their room, have never seen anyone smoke in their room and that they are aware of house rules stating they cannot smoke in their room.

In regards to the allegation: "Resident pushed by another resident": On 12/15/21 LPA interviewed Staff and Resident who were present during the time of incident and were not able to corroborate Resident pushed by another Resident. R1-R5 were interviewed on 12/15/2021. (3) out of (5) residents stated they have been pushed before, but staff do their best to separate residents who don't get along and mitigate future altercations. (5) out of (5) staff stated they do their best to separate residents who don't get along and mitigate future altercations.

In regards to the allegation: "Resident was not accorded a healthful accommodation" On 12/22/21 LPA interviewed Administrator. Administrator denied the allegation and stated a sink was installed in the patio area adjacent to the restroom area for the purpose of washing your hands after using the restroom. On 12/22/2021 LPA interviewed R1-R5, (5) out of (5) residents have their own restroom to use and stated they only use the restroom in the main facility for emergency purposes only. (4) out of (5) residents stated washing their hands in the sink located in the patio area is acceptable.

Based on LPA's interviews, the investigation revealed: 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: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Nina Galarza	TELEPHONE: 323-981-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2021

LIC9099 (FAS) - (06/04)

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