197608401-4-9-2024-31-AS-NGID-D55SAC-20240510134205

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 04/09/2024
Date Signed: 04/09/2024 12:02:47 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
03/20/2024 and conducted by Evaluator Leslie Ngo-Castaneda

COMPLAINT CONTROL NUMBER: 31-AS-20240320104246

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: 53	DATE:	04/09/2024
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Peter Babaian- Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff did not seek, medical attention after the resident suffered significant injuries.

INVESTIGATION FINDINGS:

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On 4.9.2024 Licensing Program Analyst (LPAs) Leslie Ngo-Castaneda and Raymond Comer arrived at the facility to conduct an unannounced subsequent visit to deliver the determination on the above allegations. LPA was greeted by Peter Babaian (S1) who is the administrator of the facility.

At 10:45 AM LPA conducted a physical plant tour to ensure the health and safety of the residents in care.

Allegation: Staff did not seek medical attention, after the resident suffered significant injuries.

Licensing Program Analyst (LPAs) Leslie Ngo-Castaneda and Raymond Comer conducted a subsequent complaint visit. Regarding the allegation above it is alleged that staff did not seek medical attention after the resident suffered significant injuries.

Continue to LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

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-20240320104246

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: 04/09/2024

NARRATIVE

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On 03.20.2024 LPA Leslie Ngo-Castaneda initiated this investigation into the complaint. LPA requested and reviewed the staff roster, resident roster, residents’ physician’s report, admissions agreement, appraisals, and incidents reports. On 3.22.2024 and 3.26.2024 LPA requested medical documents from Glendale Memorial Hospital. Medical records were reviewed on 3.26.2024 and 3.29.2024.

It was alleged that R1 had fallen in their bedroom (room 6) and was unconscious for three (3) hours.
R1 stated that they were at the hospital for three (3) days and that a CT scan was done and revealed that their nose was broken, their jaw was dislocated, and multiple spine bones were injured. To investigate the complaint, LPA interviewed twelve (12) out of fifty-three (53) residents. LPA also interviewed seven (7) out of seventeen (17) staff . During the interview with residents, all the residents stated that their medical needs are attended to; if higher care is needed by the residents it was advised to LPA that 911 would be called or the facility would take residents to the emergency room (ER). R1 is compliant with all their medications given at the facility. During the interview with the residents, all of them stated that they have no complaints regarding their medical needs, and everyone is satisfied. During the interview with staff, it was revealed that S2 and S6 stated that R1 would tend to complain a lot about being in pain just to ‘obtain a prescription, especially during the weekends'. According to staff, since R1 assumes that their medical care is being ignored, R1 would just roll themselves in their wheelchair to the emergency room, which is just across the street, Glendale Memorial Hospital.

On March 22, 2024, and March 27, 2024, LPA received medical records from Glendale Memorial Hospital. R1 was at the ER with the following dates: 2.9.2024, 2.18.2024, 2.21.2024, 2.24.2024, 2.25.2024, 2.28.2024, 3.14.2024, 3.16.2024 (R1 left without being seen), and 3.19.2024. LPA reviewed records from February until March 27, 2024, there is NO indication that R1 was in the hospital as an inpatient. No records indicated that CT was done on any injuries to any of R1 body parts. Records indicated that R1 goes to the ER because of ‘body pain’ because of fibromyalgia. Based on the interviews and record review obtained, this allegation is therefore unsubstantiated.

Exit interview conducted and copy of this report signed and delivered.

SUPERVISOR'S NAME: Nichelle Gillyard	TELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Leslie Ngo-Castaneda	TELEPHONE: (818) 214-9900
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC9099 (FAS) - (06/04)

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