197608401-3-15-2023-28-AS-MVAO-CQMUPN-20230406154549

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 03/15/2023
Date Signed: 03/15/2023 03:11:05 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,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/30/2023 and conducted by Evaluator Troy Agard

COMPLAINT CONTROL NUMBER: 28-AS-20230130154427

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:	03/15/2023
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Peter Babaian		TIME COMPLETED:	03:10 PM

ALLEGATION(S):

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Licensee does not ensure facility doors are kept in good repair
Licensee allows residents to access hazardous area on facility premises

INVESTIGATION FINDINGS:

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On 03/15/2023 Licensing Program Analyst (LPA) Troy Agard conducted a subsequent complaint investigation at the above facility to address the following allegations. LPA Agard was met first by Alise Nazarian, Assistant Administrator, and then by Peter Babaian, Administrator. LPA explained the purpose of this visit was to gather information and deliver findings for this complaint.

The investigation consisted of the following: On 02/01/2023, LPA toured the physical plant. LPA requested the following records: 1) staff roster, 2) resident roster. All records were received at the time of visit.

cont on 9099

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

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-20230130154427

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: VICTOR ROYALE, LLC	FACILITY NUMBER: 197608401
	VISIT DATE: 03/15/2023

NARRATIVE

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The investigation revealed the following: Regarding the allegation… Licensee does not ensure facility doors are kept in good repair. It’s being alleged the facility has a back door that is in disrepair and is being locked with use of a cord tied around the door handles from the inside of the building. LPA interviewed 5 out of 54 residents in total. 1 out of 5 confirmed the allegation. R2-5 all denied the allegation. Agreeing that they have no issues going in and out of the facility nor observing the facility doors to be obstructed. During interviews with staff, LPA Agard interviewed 2 out of 16 in total. 0 out of 2 were able to confirm the allegation. S1 states, “the doors are not broken, blocked off, tied or locked to the residents.” S2 states, “there are no issues with the doors. They are never tied locked because the residents need to be able to come in and out of the main building.”

Regarding the allegation: Licensee allows residents to access hazardous area on facility premises. It’s being alleged the facility has a vacant cottage that is currently vacant due to fire damage. The vacant cottage is currently not being locked which is a safety concern as other residents could potentially enter the unsafe building.” 1 out of 5 confirmed the allegation. R2-5 denied going to this area of the facility grounds or observing any other residents go into these premises. R4 states, “there is no reason for us to go in there… there is nothing in there. It had a fire and we know not to go in there.” During interviews with staff, 0 out of 2 confirm the allegation. S1 states, “Residents are not allowed in there and if they go in there it is without our permission. As you can see it’s blocked off. There is no furniture in the building so no one should be in there.” S2 states, “We have architects that are accessing the building, but no residents go inside there. The insurance company is about to start repairs.”

During a facility tour, LPA Agard did not observe any facility doors to be in disrepair. LPA did observe a set of facility doors held open by bricks. LPA observed the concrete below that door seal to be too low to use a pull-down door stop. LPA advised the facility Administrator to obtain a thick rubber door stop to hold doors in place as an alternative. LPA observed cottage to be vacant and blocked off for usage. LPA also observed yellow caution tape.

Based on LPA’s observation, and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation(s) may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of the report was given.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Troy Agard	TELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:	DATE: 03/15/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/15/2023

LIC9099 (FAS) - (06/04)

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