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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 06/27/2024
Date Signed: 06/27/2024 01:31:50 PM

Substantiated


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
06/26/2024 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20240626084154
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: 55DATE:
06/27/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Peter BabaianTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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 Staff did not maintain the hot water temperature
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an initial complaint visit to address the allegation mentioned above. LPA met with Licensing Vocational Nurse (LVN) Amy Smbatuni who was informed the reason of the visit. Administrator Peter Babaian arrived later and was made aware of the visit. The following information was obtained:

It was alleged staff did not maintain the hot water temperature. During the visit, from 930am to 130pm, LPA conducted a physical plant inspection, and interviews. LPA measured the hot water in several rooms, including the outside sink, located on the patio. The temperatures ranged from 102.0 to 125.6 degrees Fahrenheit. According to Title 22 regulations, hot water must be between 105.0 and 120.00 degrees. During the visit, the water was adjusted, and LPA retested the temperature, and it was measured at 120.0 degrees. This could be a potential health and safety risk to residents in care in care. Therefore, based on the physical plant inspection, the allegation is Substantiated, and the plan of correction was cleared during the visit. No further action needs to be taken, water in compliance. Exit interview and copy of report provided.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
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 2
Control Number 31-AS-20240626084154
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/27/2024
Section Cited
CCR
87303(e)(2)
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Maintenance operation: (e) Water supplies and plumbing fixtures shall be maintained as follows:(2 Faucets used by residents for personal care such as shaving and grooming shall be...maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of...
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Plan of Correction completed during the visit. Water was adjusted and re-tested. LPA measured water at 120.0 degrees, which is in compliance.
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... not less than 105 degree F...and not more than 120 degree F...This requirement was not met, evidenced by; based on water temperature ranged from 102.0 to 125.6 degrees. This is a potential health and safety risk to residents in care.

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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: Troy AgardTELEPHONE: (818) -596-4334
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 06/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024
LIC9099 (FAS) - (06/04)
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