197608401-6-5-2024-31-AS-NMAN-D68UAC-20240614152431

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608401
Report Date: 06/05/2024
Date Signed: 06/05/2024 03:48:03 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
06/04/2024 and conducted by Evaluator Rosaura Valenzuela

COMPLAINT CONTROL NUMBER: 31-AS-20240604082740

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:	06/05/2024
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Peter Babaian, Administrater		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Resident fell due to staff neglect

Staff did not ensure the floors were not in disrepair

INVESTIGATION FINDINGS:

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

It was reported that a Resdient fell due to staff neglect. Resident #1 (R1) had an unwitnessed fall while using a wheelchair. To investigate this allegation on 06/05/24, between 1:15pm and 1:45pm, staff interviews were initiated. Interviews revealed that R1 can walk on their own, but prefers to use a wheelchair. On 06/03/24, the day of the fall, R1 did not ask staff for assistance to enter or exit their room, nor did anyone witness the fall. Staff assesed R1 and determine that no injuries were sustained.. Between 1:45pm and 2:10pm, facility records were reviewed. Records revealed that R1 is ambulatory, but due to their physical condition uses a wheelchair at times. LPA attempted to speak to R1, but could not since they were upset, yelling, and using profanity.

Based on interviews and records review there is not sufficient information to support this allegation. Therefore, the 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: 06/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024

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-20240604082740

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: 06/05/2024

NARRATIVE

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It was alleged that Staff did not ensure the floors were not in disrepair. To investigate this allegation, on 06/05/24, between 1:15pm and 1:45pm, staff interviews were initiated. Interviews revealed that a new floor is being installed. The previous floor had gaps and that is why it was removed. Facility notified verbally all residents and Licensing that a new floor was going to be installed. Between 2:20pm and 2:45pm, LPA walked around the facility. LPA observed that a new floor was being installed and did not see any holes or debris on the floor. The new floor did not look like it was in disrepair. The person installing the floor said the work would be completed by today, 06/05/24.

Based on interviews and observation, there is not sufficient information to support this allegation. Hence, the allegation, is UNSUBSTANTIATED at this time.

No health and safety issues noted at the time of this visit.

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: 06/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024

LIC9099 (FAS) - (06/04)

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