197608401-12-27-2022-28-AS-RRAZ-CQTUNM-20230412154411

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 12/27/2022
Date Signed: 12/27/2022 02:18:05 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
12/21/2022 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 28-AS-20221221141050

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:	DATE:	12/27/2022
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Peter Babaian - Administrator		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Staff do not follow COVID-19 protocol

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Peter Babaian and explained the reason for the visit.

LPA conducted physical plant tour at 9:45 AM, requested facility documents at 10:10 AM and interviewed residents and staff between 10:30 AM to 1:10 PM. LPA's observation during physical plant tour between 9:45 to 10:10 AM revealed that the staff are wearing masks even the contractors working inside the facility and all Covid posters are posted all over the facility including the main entrance door. LPA also observed that the facility has 30 day supplies of PPE in their storage. LPA was screened during entrance. LPA also observed that there were hand sanitizers installed along the hallways of the facility and in the Cottage alone, there were three (3) working hand sanitizers installed. Further, all common bathrooms have liquid hand soap and a working hand dryer installed. LPA's interview with five (5) residents or 10% of the current census also revealed that they were provided all hygiene supplies by the facility regularly. Based on the information gathered during this visit, the allegation is deemed unsubstantiated at this time. Exit interview conducted. Copy of this report issued.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alex Estrada	TELEPHONE: (818) 596-4364
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 12/27/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/27/2022

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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