197608401-10-11-2022-28-AS-RORN-CKCMRT-20221019095052

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 10/11/2022
Date Signed: 10/11/2022 01:47:48 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
10/03/2022 and conducted by Evaluator Valeria Maldonado

COMPLAINT CONTROL NUMBER: 28-AS-20221003114934

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:	10/11/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Peter Babaian- Adminstrator		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not prevent resident from making inappropriate comment(s) to another resident.
Staff did not ensure resident was provided with a seat during mealtime.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) V. Maldonado made an unannouced initial complaint visit at the facility for the purpose of investigating the above mentioned allegations. LPA Maldonado met with Assistant Administrator Alise Nazarian and explained the purpose for the visit. Administrator Peter Babaian arrived shortly after and assisted with the visit.

During today's visit, LPA obtained a copy of the resident and staff roster, interviewed Residents #1-5 (R1-R5) and Staff #1-4 (S1-S4), and obtained copies of the following documents for R1-R5: Facesheet, Physician's Report, and Needs and Services Plan.

Regarding allegation: Staff did not prevent resident from making inappropriate comment(s) to another resident.

(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: 10/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022

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-20221003114934

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: 10/11/2022

NARRATIVE

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During interviews conducted with S1-S4, (1) of (4) staff stated that some residents have expressed that they do not like to have R1 around at the time they are eating because R1 smells due to poor hygiene. R1 does not comply with bathing or changing of clothes. It is noted per R1's Needs and Services Plan that R1 has refused in the past to comply with this and continues to refuse, resulting in complaints from other residents to the administrator. (3) of (4) staff interviewed denied having witnessed, or have knowledge of an incident where a resident made inappropriate comments to another resident in care. During interviews conducted with R1-R5, (4) of (5) residents denied witnessing or having knowledge of an incident where a resident made inappropriate comments to another resident in care.

Regarding allegation: Staff did not ensure resident was provided with a seat during mealtime.
During interviews conducted with S1-S4, (2) of (4) staff do not recall an incident where a resident was not provided with a seat during mealtime. S1 stated that S1 recalls an incident that occurred between R1 and R2 during dinner time a few weeks ago. S1 states that R1 came to S1 office to inform S1 that R2 was not allowing R1 to have a seat at the table where R2 was, although the seat was available. S1 states S1 went to the dining room to investigate what occurred and was informed by R2 that R2 did not want R1 to sit at that table because R1 "smelled". S1 states that there were other seats available for R1 to sit at, however R1 was adamant about sitting at that particular seat. S1 states S1 gave R1 the option of waiting for that table to become unoccupied if R1 really wanted that seat. S1 states S1 saw R1 go wait by the dining room entrance door and S1 left the dining room after that. S1 could not confirm if R1 sat down to have dinner after the incident. S3 stated to have witnessed the incident and states that R1 always has particular seats R1 would like to sit at, and if not possible, R1 will wait until the seat becomes available. S3 could not recall if R1 sat down to have dinner that day. During the interview conducted with R1, it was stated that the issue was not resolved by S1 as R1 would have liked. R1 states that after S1 gave R1 the option of waiting for the table to become unoccupied, R1 decided to try another table- which is the table designated for non-ambulatory residents. R1 states R1 was standing at the table and waited to be served; however the server never brought R1 food. R1 stated that after 2 attempts of trying to sit to have dinner, R1 decided to leave and not have dinner at all. During interviews with R1-R5, (3) of (5) residents stated to to not recall such incident where a resident was not provided a seat during mealtime. (1) of (5) residents stated to recall the incident, but could not confirm whether R1 was sat or was provided a seat during mealtime.

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

Per Title 22, California Code of Regulations, no deficiencies were cited during today's visit.

An exit interview was conducted with Administrator Peter Babaian and a copy of this 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: 10/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2022

LIC9099 (FAS) - (06/04)

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