197609001-2-20-2024-31-AS-MVAO-D3YTRS-20240403145800

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609001
Report Date: 02/20/2024
Date Signed: 02/20/2024 12:09:25 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
02/12/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240212094252

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: 5	DATE:	02/20/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Karine Charchoglyan		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff cashed a resident's social security check who does not live at the facility anymore

INVESTIGATION FINDINGS:

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At 9:45 a.m. on 02/20/2024, Licensing Program Analysts (LPAs) Nicholas Reed and Raymond Comer conducted an unannounced complaint visit. LPAs met with Staff #1 (S1) and disclosed the reason for the visit. S1 and LPAs called the licensee at approximately 10:10 a.m. and disclosed the reason for the visit.

To investigate the allegation above, LPAs interviewed five (05) out of five (05) residents and two (02) out of two (02) staff between 10:00 a.m. and 11:30 a.m., requested records pertinent to the investigation at 11:15 a.m. including but not limited to the staff list, resident list, admission agreement, medical assessment, and care plan, and toured the facility at 10:00 a.m.

Regarding the allegation ”Staff cashed a resident's social security check who does not live at the facility anymore” it was alleged that Resident #1 (R1) was missing their Social Security check for the month of October 2023. When R1 spoke with Social Security, they were informed it had been cashed.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

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 5

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
02/12/2024 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20240212094252

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: 5	DATE:	02/20/2024
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	Karine Charchoglyan		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

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Staff refuse to refund resident

INVESTIGATION FINDINGS:

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At 9:45 a.m. on 02/20/2024, Licensing Program Analysts (LPAs) Nicholas Reed and Raymond Comer conducted an unannounced complaint visit. LPAs met with Staff #1 (S1) and disclosed the reason for the visit. S1 and LPAs called the licensee at approximately 10:10 a.m. and disclosed the reason for the visit.

To investigate the allegation above, LPAs interviewed five (05) out of five (05) residents and two (02) out of two (02) staff between 10:00 a.m. and 11:30 a.m., requested records pertinent to the investigation at 11:15 a.m. including but not limited to the staff list, resident list, admission agreement, medical assessment, and care plan, and toured the facility at 10:00 a.m.

Regarding the allegation ”Staff refuse to refund resident” it was alleged R1 was unable to contact the facility for a refund of their October 2023 check. Interview with the licensee today at 10:30 a.m. revealed they were willing to take all necessary steps to refund R1’s check.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

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

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 31-AS-20240212094252

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: ROYALTY ASSISTED LIVING	FACILITY NUMBER: 197609001
	VISIT DATE: 02/20/2024

NARRATIVE

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S1 and the licensee stated they did not know of any attempts of R1 to contact the facility regarding a refund. Based on interviews, the facility is willing to refund R1’s check and was not aware of any attempted phone calls requesting a refund. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

No immediate health and safety hazards were observed during this visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 31-AS-20240212094252

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: ROYALTY ASSISTED LIVING	FACILITY NUMBER: 197609001
	VISIT DATE: 02/20/2024

NARRATIVE

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R1 left the facility on or prior to 09/25/2023. Interview the administrator of R1’s new facility at 8:30 a.m. today revealed R1 had spoken with Social Security and has been unable to pay rent at the new facility since October of 2023. Interview with the licensee today at 10:30 a.m. revealed that the facility had mistakenly cashed R1’s check for the month of October 2023. The licensee agreed to take all necessary action to reimburse R1. Based on interviews, the facility cashed R1’s check after they were no longer a resident. Therefore, the allegation is deemed SUBSTANTIATED at this time. Deficiency is cited on the attached LIC 9099-D page.

No immediate health and safety hazards were observed during this visit.

Exit interview conducted. Appeal rights discussed. Copy of report provided.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 31-AS-20240212094252

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: ROYALTY ASSISTED LIVING	FACILITY NUMBER: 197609001
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/20/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/01/2024 Section Cited CCR 87468.1(a)(3)	1 2 3 4 5 6 7	87468.1 Personal Rights of Residents in All Facilities (a) Residents... shall have all of the following personal rights: (3)To be free from... withholding residents’ money This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Licensee has agreed to reimburse the resident by refunding the October 2023 check to the Social Security Administration by the POC due date.
	8 9 10 11 12 13 14	Based on interviews, the licensee did not comply with the section cited above in (01) out of (06) residents which poses a potential Health, Safety, or Personal Rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Nicholas Reed	TELEPHONE: (818) 669-8178
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

LIC9099 (FAS) - (06/04)

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