197608401-11-3-2022-28-AS-FFIS-CMZVFE-20230112152350

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 11/03/2022
Date Signed: 11/03/2022 03:00:52 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
10/28/2022 and conducted by Evaluator Ashley Calderon

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221028142050

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: 49	DATE:	11/03/2022
		UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Alise Nazarian - Assistant Administrator		TIME COMPLETED:	03:05 PM

ALLEGATION(S):

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Facility staff did not clean up feces on floor of the facility.

INVESTIGATION FINDINGS:

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Licenising Program Analyst (LPA) Ashley Calderon conducted an unannounced complaint visit to the above facility. LPA Calderon met wirh Alise Nazarian, assistant administrator and discussed the purpose of todays visit.

LPA Calderon and Alise toured the common areas of the physcial plant, toured main facility and the two cottages on premesis.LPA Calderon collected staff and residents roster, and interviewed resident and staff.

Continuation on 9099C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

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-20221028142050

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: 11/03/2022

NARRATIVE

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***This is an amended report***

Today's investigation revealed the following. In regards to the allegation facility staff did not clean up feces on floor of facility. It was alleged that in the cottages a resident appeared to be smearing feces and facility should be afforded safe, clean and comfortable accommodations. LPA toured with Alise Narzarian the cottage building, the hallways, common spaces and observed the facility was clean and sanitary. LPA Calderon interviewed staff and residents. 5 out of 5 staff who were interviewed stated the facility is cleaned every day. 4 of 5 staff interviewed denied the allegation and stated they were not aware of the incident stated in the allegation in regards to feces on the floor. S3 stated it was brought up to S3's attention that a resident mentioned that there was feces being smeared on the floor in the cottage building and S3 told housekeeping staff to see if cleaning is needed. S3 did not observe feces on the floor. LPA Calderon interviewed S4 and S5 both denied being aware of cleaning the feces and being aware of the incident. 5 out of 5 residents during interviews with LPA denied seeing feces on the floor. R3 stated a resident did tell R3 about the feces on the floor and when R3 looked in the area that the feces was allegedly at, R3 did not observe any feces on the floor. R1 stated seeing a resident on the floor which appeared to be smearing stuff on the floor but R1 was not sure what is was and if it was feces. R1 stated there was no odor. 5 out of 5 resident stated the facility is kept clean, and cleaning happens regularly.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were cited. A copy of this report will be emailed to Peter Babaian, signature will be on hard copy.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Ashley Calderon	TELEPHONE: (323) 981-3984
LICENSING EVALUATOR SIGNATURE:	DATE: 01/10/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/10/2023

LIC9099 (FAS) - (06/04)

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