197608401-1-18-2024-31-AS-RVAA-CZM39K-20240118170318

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608401
Report Date: 01/18/2024
Date Signed: 01/18/2024 05:03:32 PM

Document Has Been Signed on 01/18/2024 05:03 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
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: 55	DATE:	01/18/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:38 PM
MET WITH:	Peter Babian, Administratorm		TIME COMPLETED:	05:00 PM

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	Licensing Program Analyst (LPA) Rosaura Valenzuela made an unannounced visit to the facility for the purpose of conducting the required annual inspection. LPA Valenzuela met with Administrator Peter Babaian and explained the purpose for the visit. The facility has an approved mitigation plan on file. The facility is a one-story building located in a residential area. It is licensed to serve (60) elderly residents, ages 60 and over, of which (49) may be non-ambulatory and (4) may be bedridden in rooms# 11 and #28 only. The property also has (2) cottages, #1511 & #1515 reserved for ambulatory residents only and has a hospice waiver approved for (6). The building consists of a living room, kitchen, dining room, 29 resident bedrooms with restrooms, common showers and bathrooms with required grab bars and non-skid mats, a laundry room/storage located in the basement, and a shaded patio in the backyard with seating. The cottages are located across the back yard and each have 4 bedrooms with a shared bathroom/shower, which had the required grab bars and non-skid mats. LPA observed resident bedrooms# 4, 7, 23, and 29 to have the required furniture, bedding, linens, sufficient lighting, closet space, and additional storage space. Each room had a bathroom and were observed to have a toilet with the required grab bars and a wash basin. The water temperature was tested in the bathrooms of each room observed and in cottage# 1511, and measured between 111F-119F, which is in compliance with Title 22 Regulations. The food supplies was observed to be the required 2-day perishables and 7-day non-perishables. Several fire extinguishers were observed throughout the building and in the cottages to have current inspections and were fully charged. All sharps were observed to be locked and inaccessible in the kitchen. Cleaning supplies were locked and inaccessible, stored in cabinets in the basement and in a storage shed in the back yard. All laundry and kitchen equipment was operational and in good repair. The smoke/carbon monoxide detectors were tested, were interconnected and operational at the time of the visit. Continue on 809C

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 01/18/2024

NARRATIVE

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There is one central entry point. No bodies of water observed. There is one complete first aid kit.

(5) random resident files were reviewed and had updated emergency contact information and health screenings. (3) random staff files were reviewed and had Criminal Background Clearances, health screenings, and proof of required annual training and certifications.

At this time no health and safety noted. No citations will be issued.

An exit interview was conducted with Administrator Peter Babaian and a copy of this report was given.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Rosaura Valenzuela	TELEPHONE: 818-596-4334
LICENSING EVALUATOR SIGNATURE:	DATE: 01/18/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/18/2024

LIC809 (FAS) - (06/04)

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