197608401-1-3-2024-31-AS-NMAN-CZBQ8D-20240109105632

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 01/03/2024
Date Signed: 01/03/2024 03:47:29 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.RO, 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
12/28/2023 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20231228163838

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: 56	DATE:	01/03/2024
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Peter Babaian, Administrator		TIME COMPLETED:	03:50 PM

ALLEGATION(S):

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Staff did not notify resident of positive COVID test

Staff did not provide resident with medical records upon request

Staff did not quarantine resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Rosaura Valenzuela conducted an unannounced visit for the above noted allegations. LPA met with Administrator Peter Babaian and explained the reason for the visit.

It was reported that staff did not notify resident of a positive COVID test result. To investigate this allegation on 1/03/2024, between 2:00pm and 2:30pm, facility records were requested and reviewed. Records revealed that on 10/25/2023, Resident #1 (R1) was tested for COVID-19. The results came back ABNORMAL, but did not verify that they were COVID positive. On 11/01/2023, R1 was once again tested for COVID and the resutls stated that the virus was not detected. Between 2:30pm and 3:00pm, staff interviews were intitated. Interviews revealed that R1 was not COVID positive, but that their results were inconclusive. The facility did notify R1 of the results and told them to stay inside their room out of precaution.

Based on interviews and records review, there is not sufficient information to verify this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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-20231228163838

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: VICTOR ROYALE, LLC	FACILITY NUMBER: 197608401
	VISIT DATE: 01/03/2024

NARRATIVE

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It was alleged that staff did not provide resident with medical records upon request. To investigate this allegation on 1/03/2024, between 2:30pm and 3:00pm, staff interviews were initiated. Interviews revealed that the facility does not store the medical records of R1. R1 needs to request medical records from their doctor. In addition, R1 was notified of the ABNORMAL Covid test results taken on 10/25/2023. According to staff, R1 was given a copy of their COVID test results in a timely manner.

Based on interviews there is not sufficient information to verify this allegation. Thus, this allegation is UNSUBSTANTIATED at this time.

It was reported that staff did not quarantine resident. To investigate this allegation on 1/03/2024, between 2:30pm and 3:00pm, staff interviews were initiated. Interviews revealed that R1 was told to quarantine out of precaution, due to the fact that their test results were ABNORMAL for Covid-19 on 10/25/2023.

Based on interviews, there is not sufficient information to support this allegation. Therefore, this allegation is UNSUBSTANTIATED at this time.

Exit interview conducted and a copy of the report was issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC9099 (FAS) - (06/04)

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