<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609001
Report Date:
02/08/2022
Date Signed:
02/08/2022 03:24:22 PM
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office
,
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
02/04/2022
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20220204094227
FACILITY NAME:
ROYALTY ASSISTED LIVING
FACILITY NUMBER:
197609001
ADMINISTRATOR:
AVETIAN, LIDUSH
FACILITY TYPE:
740
ADDRESS:
10940 STRATHERN STREET
TELEPHONE:
(818) 436-9088
CITY:
SUN VALLEY
STATE:
CA
ZIP CODE:
91352
CAPACITY:
10
CENSUS:
8
DATE:
02/08/2022
UNANNOUNCED
TIME BEGAN:
10:00 AM
MET WITH:
Kara Charchoghlyan
TIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Lack of Supervision
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced complaint visit to investigate the allegation above. LPA met with facility staff and explained the reason for this visit. LPA spoke with the administrator by telephone and explained the reason for this visit.
It is alleged that resident #1 (R1) was not properly supervised based on R1 being found outside of the facility passed out and having to be transported to the hospital. Upon entry to the facility LPA conducted a physical plant walk through from 10-10:15am to ensure no immediate health and safety issues. LPA conducted an interview with facility staff from 10:15-10:45am. LPA reviewed R1's facility file and obtained copies of pertinent information from 10:45-11:30am. LPA interviewed R1 from approximately 11:30-12:15pm regarding the allegation. LPA also interviewed R1's family member by telephone. Interviews and a review of R1's facility file indicate that R1 is able to leave the facility unassisted. On 2/2/22 R1 was outside of the facility when they passed out and had to be transported to the hospital. Facility thought that R1 went to visit their family which R1 does frequently. Based on the information obtained through interviews and review of R1's facility file this allegation is deemed Unsubstantiated at this time. Exit interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
02/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
02/08/2022
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
1