<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 08/03/2023
Date Signed: 08/03/2023 02:20:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/25/2023 and conducted by Evaluator LaQueena Lacy
COMPLAINT CONTROL NUMBER: 31-AS-20230725120049
FACILITY NAME:VICTOR ROYALE, LLCFACILITY NUMBER:
197608401
ADMINISTRATOR:PETER BABAIANFACILITY TYPE:
740
ADDRESS:120 E. LAUREL STREETTELEPHONE:
(818) 243-7442
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:60CENSUS: 54DATE:
08/03/2023
UNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Peter BabaianTIME COMPLETED:
02:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
 Staff did not report incident to the appropriate agencies.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced initial 10day complaint visit on 08/03/2023, LPA arrived at the facility at 9:20am. At approximately 9:58am LPA met with Administrator Peter Babaian and explained the purpose of the visit.

LPA conducted a physical plant tour at 10:07am.

It is alleged that the facility failed to report an altercation between resident #1 (R1) and resident #2 (R2) to the appropriate agencies. LPA requested and obtained copies of facility files and documents including but not limited to the staff and resident rosters, physician reports and appraisal/needs and service plan at approximately 10:19am. LPA began interviews with the Administrator, staff, and residents at approximately 10:30am between 11:56am. During the investigation the the administrator confirmed they did not report the alleged incident to the appropriate agencies because they conducted an internal investigation and could not
Continued on 9099C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 31-AS-20230725120049
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VICTOR ROYALE, LLC
FACILITY NUMBER: 197608401
VISIT DATE: 08/03/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
conclude the alleged incident occurred. LPA informed the administrator per reporting requirements and as a mandated reporter their duty is to report incidents accordingly to the appropriate agencies. Although the administrator completed the required reporting forms to the appropriate agencies at the time of the investigation Based on interviews, observations and record review, there is enough evidence to prove the alleged violation did occur, therefore the allegation is SUBSTANTIATED at this time.

No health and safety hazards are noted during this visit.

Deficiency cited, exit interview conducted and a copy of report and appeal rights issued.

SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/25/2023 and conducted by Evaluator LaQueena Lacy
COMPLAINT CONTROL NUMBER: 31-AS-20230725120049

FACILITY NAME:VICTOR ROYALE, LLCFACILITY NUMBER:
197608401
ADMINISTRATOR:PETER BABAIANFACILITY TYPE:
740
ADDRESS:120 E. LAUREL STREETTELEPHONE:
(818) 243-7442
CITY:GLENDALESTATE: CAZIP CODE:
91205
CAPACITY:60CENSUS: 54DATE:
08/03/2023
UNANNOUNCEDTIME BEGAN:
09:24 AM
MET WITH:Peter BabaianTIME COMPLETED:
02:25 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident handled another resident in an inappropriate manner causing bruising.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) LaQueena Lacy conducted an unannounced initial 10day complaint visit on 08/03/2023, LPA arrived at the facility at 9:20am. At approximately 9:58am LPA met with Administrator Peter Babaian and explained the purpose of the visit.

LPA conducted a physical plant tour at 10:07am.

It is alleged that resident #2 (R2) roughly grabbed resident #1 (R1) by the arm and caused a bruise in an attempt to move them. LPA requested and obtained copies of facility files and documents including but not limited to the staff, and resident rosters, physician reports and appraisal/needs and service plan at approximately 10:19am. LPA began interviews with the Administrator, staff and residents at approximately 10:22am between 11:56am. Interviews with four (04) out of five (05) residents confirm they did not witness the alleged altercation between R1 and R2. R2 affirmed they never grabbed R1 by the arm or tried to move R1. Continued on 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 31-AS-20230725120049
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: VICTOR ROYALE, LLC
FACILITY NUMBER: 197608401
VISIT DATE: 08/03/2023
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Interviews with staff confirm they were not told by any residents regarding the incident and did not witness the altercation. During the investigation LPA observed cameras in the facility common areas, per the administrator the camera system has been inoperable for about a month and was not operating at the time of the alleged incident. LPA observed the surveillance system in the administrator office to be non-functional at the time of the investigation. Upon record review of a photograph of R1s bruise it could not be concluded when or how the bruise was obtained. Based on interviews, observations, and record review, there is a not enough corroborating evidence to prove that the alleged violation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazards are noted during this visit.


No deficiencies cited, exit interview conducted. Copy of report, and appeal rights issued.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20230725120049
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: VICTOR ROYALE, LLC
FACILITY NUMBER: 197608401
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/17/2023
Section Cited
CCR
87211(c)
1
2
3
4
5
6
7
87211 Reporting Requirements(c)Any suspected physical abuse that does not result in serious bodily injury... shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency...This requirement is not met as evidenced by:
1
2
3
4
5
6
7
At the time of the visit the administrator complete the appropriate required reporting forms and submitted to the appropriate agencies. The administrator will conduct an in-service on reporting requirements and mandated reporting and submit by email to LPA by POC due date.
8
9
10
11
12
13
14
Based on interviews, observation and record review the licensee failed to ensure that suspected physical abuse was reported to the appropriate agencies in a timely manner.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena LacyTELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5