197608401-8-31-2023-31-AS-MVAO-CWRMHX-20231019093817

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 08/31/2023
Date Signed: 08/31/2023 02:36:38 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
06/21/2023 and conducted by Evaluator Jose Gary Tan

COMPLAINT CONTROL NUMBER: 31-AS-20230621160636

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: 54	DATE:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	09:16 AM
MET WITH:	Peter Babaian - Administrator		TIME COMPLETED:	01:15 PM

ALLEGATION(S):

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Staff does not administer resident's medication as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Gary Tan conducted an unannounced subsequent complaint visit at this facility to further investigate the above allegation.

LPA conducted physical plant tour at 9:40 AM, requested copy of facility documents relevant to the investigation at 10:02 AM and interviewed staff and resident between 10:30 AM to 1:00 PM. It was alleged that Resident #1 (R1)'s medication was not given to R1 as prescribed by R1's physician. LPA's record review today at 11:20 AM revealed that R1's physician's prescription state that the particular medication was ordered to be taken orally once a day with no specific time to be taken. Further review also revealed that R1 did not miss any medication for the last three (3) months. LPA's interview with R1 on 06/22/23 at 10:45 AM revealed that R1 took the prescribed medication on the day in question (06/21/23) with an approximate delay of about an hour which is well within the time frame of medication administration.

(continued on LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

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-20230621160636

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: VICTOR ROYALE, LLC	FACILITY NUMBER: 197608401
	VISIT DATE: 08/31/2023

NARRATIVE

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(continued from LIC 9099)

LPA's interview with staff also revealed that the reason for the delay was that R1's morning medication was wrapped and sealed all together and the medication staff has to be present when opened to ensure that R1 takes all of R1's medication while in the facility as R1 did not go to the day program on the day in question (06/21/23) because when R1 is at the day program, staff at the program monitors R1 medication intake.

Based on the information gathered during this and prior visit, the allegation is deemed unsubstantiated at this time.

Exit interview conducted. Copy of this report issued.

SUPERVISOR'S NAME: Troy Agard	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Jose Gary Tan	TELEPHONE: (323) 213-1149
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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