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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609001
Report Date: 06/11/2024
Date Signed: 06/11/2024 02:12:42 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
06/07/2023 and conducted by Evaluator Antonia Alvizar-Ettima
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20230607163242
FACILITY NAME:ROYALTY ASSISTED LIVINGFACILITY NUMBER:
197609001
ADMINISTRATOR:AVETIAN, LIDUSHFACILITY TYPE:
740
ADDRESS:10940 STRATHERN STREETTELEPHONE:
(818) 436-9088
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:10CENSUS: 6DATE:
06/11/2024
UNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH: Karine Charchaoglyan, CaregiverTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Facility staff failed to obtain emergency services timely
illegal eviction
INVESTIGATION FINDINGS:
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At 10:15a.m. Licensing Program Analyst (LPA) Antonia Alvizar- Ettima conducted an unannounced subsequent visit to deliver the finding for the above noted allegations. LPA met with the Caregiver and explained the reason for the visit.

During initial visit on 06/14/2023 at 11:10a.m. LPA conducted a physical plant tour. At 10:15AM LPA requested copies of facility documents relevant to the investigations. At 10:40AM LPA spoke with staff, Estela Avetyan via-phone because was not at the facility. At 10:50AM LPA and Karine toured the physical plant. Between 11:00AM-11:45AM, LPA interviewed staff (S1 - S3) asking questions relevant to the nature of the complaint.

During Licensing Visit conducted on 06/11/2024 at 10:35a.m. LPA Alvizar-Ettima request staff and resident rosters. At 10:50a.m. LPA and Caregiver conducted a physical plan tour. Between 11:00a.m. – 12:30p.m. LPA interviewed six (6) out of six (6) residents. R1 had already passed away.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-EttimaTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
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-20230607163242
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: ROYALTY ASSISTED LIVING
FACILITY NUMBER: 197609001
VISIT DATE: 06/11/2024
NARRATIVE
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At about 11:25a.m. Administrator, Lidush Avetian and Director, Estela Avetyan arrived to the facility and joined the visit.
Prior to this visit on 06/10/2024 LPA reviewed R1’s facility records, including but not limited to R1’s incident and/or Death Report(s), Physician’s Report and other documents previously obtained from the facility.
1. Facility staff failed to obtain emergency services timely

It was alleged that resident #1 (R1) was unresponsive and staff refused to call 911. Staff interviews reveal that R1 was receiving services from 3rd party health care provider, due to R1 participating to the Program of All-Inclusive Care for the Elderly (PACE) Program. R1’s incidental medical care services were regulated and provided by the “PACE” Medicare and Medicaid program. Facility staff was instructed by the “PACE” representatives to call them when R1 needs emergency services. However, regardless of instructions received from “PACE” they always call 911 for resident(s) if needed and at the same time, they notify residents health care providers. Facility Administrator indicated that staff never refuses to call 911. Specifically, for R1 they have called 911 several times in the past. Six (6) out of six (6) residents interviews coincided with staff information about calling emergency services as they needed. R3 indicated seeing Emergency Medical Technicians (EMT) attending R1 and walking up and down the hallway. Residents did not address any concerns about facility staff requesting timely emergency services.

The information revealed from the interviews, and record review, does not support the allegation. Therefore, the allegation is UNSUBSTANTIATED at this time.


2. Illegally evicted

It was alleged that R1 was illegally evicted because of behavior issues. Staff interviews reveal that R1 was not evicted. Staff indicated that R1 smoked in the room and had behavioral problems. Administrator indicated that they verbally warrant R1 that violation of house rules, continuation of unacceptable behavior, and smoking in the room may bring to eviction. No written eviction notice was issued to R1. R2, who was R1’s roommate stated that they did tell R1 that it would not be a good thing to smoke in the room. Six (6) out of six (6) residents interviews revealed that staff never tried to evict them and R1 was never evicted from the facility.

A review of R1’s file and other facility records, did not reveal any information to support the allegation.


Based on interviews and documents review there is an insufficient information to support the allegations. Therefore, the allegation is UNSUBSTANTIATED at this time.

No health and safety hazard were noted during this visit.


Exit interview is conducted and copy of report was provided to Administrator.
SUPERVISOR'S NAME: Naira MargaryanTELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: Antonia Alvizar-EttimaTELEPHONE: (818) 383-6108
LICENSING EVALUATOR SIGNATURE:

DATE: 06/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2