<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197609001
Report Date: 05/28/2022
Date Signed: 05/28/2022 12:46:32 PM

Unsubstantiated


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
09/03/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210903103926
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: 13DATE:
05/28/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kara CharchaogalyanTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
1. Financial Abuse
2. Staff did not safeguard residents belongings
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit and met with caregiver Kara Charachaogalyan and informed her the reason of the visit. Both Administrators Estella and Lidush Avetian, were notified via cellphone and informed the reason of the visit. The following finding was determined:

Allegation #1: Financial Abuse: On September 10, 2021 and October 11, 2021, from 11am to 4pm, at various times, LPA conducted interviews with the complainant, staff, and residents at the facility. LPA also reviewed documents pertaining to the complaint. It was alleged, resident # 1 (R1) did not receive the personal & incentive (P&I) monthly allowance, in the amount of $138.00, for the month of August 2021. According to the interviews and documentation reviewed, R1 could not recall if R1 received the monthly stipend in the amount of $138.00 for the month of August. Documentation reviewed revealed, R1 received and signed for the money.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2022
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 5
Control Number 31-AS-20210903103926
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ROYALTY ASSISTED LIVING
FACILITY NUMBER: 197609001
VISIT DATE: 05/28/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Therefore, LPA does not have sufficient evidence to prove the allegation “Financial Abuse”, and the allegation is UNSUBSTANTIATED at this time.

Allegation # 2: Staff did not safeguard residents’ belongings: On September 10, 2021 and October 11, 2021, from 11am to 4pm, at various times, LPA conducted interviews with the complainant, staff, and residents at the facility. LPA also reviewed documents pertaining to the complaint. It was alleged, that when staff relocated R1 to another facility, R1’s personal belongings, such as clothing and electronic tablet was missing. On September 10, 2021, during the initial visit of the investigation, LPA interviewed R1, and observed the electronic tablet, that was alleged to be missing. According to R1, when R1 relocated back to the original placement, it was accidentally left at the previous relocation, but was given back to R1. LPA also observed clothing in R1’s clothing. LPA asked R1, if any clothing was left behind, and R1 stated, “no”, all the belongings in the closet were counted for. Although, it was alleged, “Staff did not safeguard residents’ belongings”, LPA did not have enough evidence to prove the allegation, therefore it is UNSUBSTANTIATED at this time.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
09/03/2021 and conducted by Evaluator Tuesday Cabiness
PUBLIC
COMPLAINT CONTROL NUMBER: 31-AS-20210903103926

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: 13DATE:
05/28/2022
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kara CharchaogalyanTIME COMPLETED:
01:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
1. Resident was involuntarily transferred to another facility
2. Resident's healthcare provider was not notified of change in facility
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Tuesday Cabiness conducted a subsequent visit and met with caregiver and Administrator to deliver the final findings of the allegations mentioned above. The following finding was determined:

Allegation # 1: Resident was involuntarily transferred to another facility. On September 10, 2021 and October 11, 2021, from 11am to 4pm, at various times, LPA conducted interviews with the complainant, staff, and residents at the facility. LPA also reviewed documents pertaining to the complaint. It was alleged, that when staff involuntarily transferred to another facility. According to interviews, staff confirmed to LPA that R1 was involuntarily transferred to the Licensee’s other facility in Granada Hills, because staff were concerned about R1’s mental health. Although staff were concerned about R1, the facility did not follow proper procedures, therefore, the allegation “Resident was involuntarily transferred to another facility” is SUBSTANTIATED. This poses as a potential health and safety risk to residents in care.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 31-AS-20210903103926
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: ROYALTY ASSISTED LIVING
FACILITY NUMBER: 197609001
VISIT DATE: 05/28/2022
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation # 2: Resident's healthcare provider was not notified of change in facility. Allegation # 1: Resident was involuntarily transferred to another facility. On September 10, 2021 and October 11, 2021, from 11am to 4pm, at various times, LPA conducted interviews with the complainant, staff, and residents at the facility. LPA also reviewed documents pertaining to the complaint. R1 participates in PACE (Program of All Inclusive Care for the Elderly). They provide services for R1, such as health care and insurance coverage, as well as services provided by doctors and nurses. Information reviewed, determined that when R1 was transferred to the facility in Granada Hills, the facility did not notify PACE, and that facility was out of there service area, and R1’s services were in jeopardy of being discontinued. The facility was to notify PACE of any changes or information pertaining to the client. Therefore, the allegation “Resident's healthcare provider was not notified of change in facility, is SUBSTANTIATED. This poses a potential health and safety risk to residents in care.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 31-AS-20210903103926
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROYALTY ASSISTED LIVING
FACILITY NUMBER: 197609001
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/10/2022
Section Cited
CCR
87224(a)
1
2
3
4
5
6
7
Eviction Procedures. The licensee may, upon thirty (30) days written notice to the resident, evict the resident for nonpayment of the rate for basic services...failure to comply with the general policies of the facility
1
2
3
4
5
6
7
Administrator has AGREED to submit in writing that they have read eviction procedures regulations, and will ensure that they will follow proper procedures when relocation residents from facility to facility.
8
9
10
11
12
13
14
development of a need not previously identified, and/or a change of use of the facility. This requirement was not met, evidenced by: through interviews R1 was relocated to another facility, and staff did not follow proper procedures. This poses a a potential health and safety risk to residents in care.
8
9
10
11
12
13
14
Type B
06/10/2022
Section Cited
CCR
87468.1
1
2
3
4
5
6
7
Personal Rights of Residents in All Facilities: (a) Residents in all residential care facilities...shall have all of the following personal rights: (8) To have their representatives regularly informed
1
2
3
4
5
6
7
Administrator has AGREED to submit in writing that they have read eviction procedures regulations, and will ensure in writing, that they will follow proper procedures for residents, such as notifying the appropriate
8
9
10
11
12
13
14
by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met, evidenced by: Facility relocated R1 without notifying R1's represetnatives. This poses a potential health and safety risk to residents in care.

8
9
10
11
12
13
14
representative, rather it's family, or any other individual (case manager, SW, or agency that represents the resident).
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: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 05/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5