197608401-12-15-2022-28-AS-RORN-CNVP5G-20230209100042

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 12/15/2022
Date Signed: 12/15/2022 11:22:09 AM

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
12/08/2022 and conducted by Evaluator Valeria Maldonado

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221208095540

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: 52	DATE:	12/15/2022
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Alise Nazarian- Assistant Administrator		TIME COMPLETED:	11:30 AM

ALLEGATION(S):

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Facility staff locked resident out of facility.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) V. Maldonado made an unannounced complaint visit at the facility for the purpose of investigating the above-mentioned allegation. LPA Maldonado met with assistant administrator Alise Nazarian and explained the purpose for the visit.

During the visit, LPA Maldonado requested a copy of the resident and staff roster. LPA also interviewed Staff#1-3 (S1-S3) and Residents# 1-5 (R1-R5).

The investigation revealed the following:

(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: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

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-20221208095540

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: 12/15/2022

NARRATIVE

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Regarding allegation- Facility staff locked resident out of facility.
It is alleged that R1 was locked out of the facility in the patio area by S3 for a total of 5 minutes, while S3 mopped. In interviews conducted with S1-S2, it was stated they have no knowledge of the incident occurring, as it was not witnessed, nor reported. During the interview conducted with R1, R1 states the incident was not reported to staff as a complaint had already been filed with Licensing and R1 did not want to hinder the investigation that would later occur. When asked about the incident, S2 denied the allegation stating R1 is a problematic resident who reports false allegations and is trying to make S3 seem like a bad person. During interviews conducted with R1-R5, (4) of (5) residents denied witnessing the R1 being locked outside in the patio. (4) of (5) residents also denied witnessing S3 locking R1, or any other resident, out of the facility. LPA observed and inspected the sliding door that leads to the patio where R1 alleges to have been locked and tried to lock the door. LPA found that the lock on the door is difficult to close, after trying multiple times to lock it with one hand. LPA had to use 2 hands to position the door to where it would lock correctly.

Based on LPA's interviews and observations, the investigation revealed: 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 during today's visit.

An exit interview was conducted with Alise Nazarian and a copy of the 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: 12/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2022

LIC9099 (FAS) - (06/04)

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