197608401-4-26-2023-31-AS-RRAZ-CRH73H-20230503211822

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 04/26/2023
Date Signed: 04/26/2023 12:58:57 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/20/2023 and conducted by Evaluator Mariana Agban

COMPLAINT CONTROL NUMBER: 31-AS-20230420141840

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:	04/26/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Peter Babaian, Adminstator		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Staff allows residents to access hazardous area on facility premises.

INVESTIGATION FINDINGS:

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At 10:00am, LPAs Mariana Agban and Angela Paunshkina initiated a complaint investigation for the allegation listed above. LPAs met with the Administrator, Peter Babaian, and explained the purpose of this visit.

LPAs conducted a physical plant walk through, at approximately 10:20am, to ensure that the facility is in compliance with rules and regulations under California Code of Regulations, Title 22, Division 6. LPAs did not observe any immediate health and safety issues during the visit.

LPAs conducted interview with the Administrator, Administrator Assistant, two (2) staff members, and five (5) residents and reviewed facility records from 10:30am to 12:00pm. LPAs also obtained copies of pertinent documents relevant to the investigation.
Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

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 31-AS-20230420141840

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
N LA & CEN COA AC/SC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: VICTOR ROYALE, LLC	FACILITY NUMBER: 197608401
	VISIT DATE: 04/26/2023

NARRATIVE

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Allegation: Staff allows residents to access hazardous area on facility premises.

It was alleged that the Administrator told Resident #2 (R2) that it was "OK" to help staff in the burnt cottage that occurred in November of 2022. To investigate this allegation, during a physical plant tour at 10:30am, LPAs observed that the burnt cottage has a fence around it and on the main entrance a cable rope (4-digit), was also observed. Administrator Assistant informed LPAs that only staff members have a code to access the burnt cottages. In addition, interview with the Administrator revealed that R2 used to reside in one of the units on a burnt side of the cottages and was temporarily moved to the other side until the repair is complete. Due to some of the residents belongings still continue being stored on a partially damaged cottage area the residents ask the staff to gain access to remove necessary items. Interviews with the Administrator, Administrator Assistant, two (2) caregivers confirmed that previous cottage tenants gain access to their belongings only under the facility staff supervision. Moreover, four (4) out of five (5) residents denied ever seeing the entrance to the burnt cottage being accessible to residents in care.

Based on information obtained through interviews and observation this allegation is deemed Unsubstantiated.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Mariana Agban	TELEPHONE: 818-738-4525
LICENSING EVALUATOR SIGNATURE:	DATE: 04/26/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2023

LIC9099 (FAS) - (06/04)

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