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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609001
Report Date: 01/26/2023
Date Signed: 01/26/2023 02:08:53 PM


Document Has Been Signed on 01/26/2023 02:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LIVINGFACILITY NUMBER:
197609001
ADMINISTRATOR:AVETIAN, LIDUSHFACILITY TYPE:
740
ADDRESS:10940 STRATHERN STREETTELEPHONE:
(818) 436-9088
CITY:SUN VALLEYSTATE: CAZIP CODE:
91352
CAPACITY:10CENSUS: 11DATE:
01/26/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Kara CharchaogalyanTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an initial visit, in conjunction to complaint control # (31-AS-20230120123514). As LPA conducted a physical plant inspection, LPA observed the facility is once again over capacity and has (11) residents in the facility, when the they are licensed for (10). LPA attempted to contact the designee , who is the daughter of the facility Estella Avetyan, who did not answer and was not available. According to caregiver Kara, the Licensee Lidish Avetian will not able to come due to car issues.

LPA has documented and cited facility on a previous visits, dated 09/13/2022 for being over capacity. The facility was cited and issued a civil penalty, and was corrected, due to the fact, the residents were removed in a timely manner. On June 06/03/2022, LPA Wendell Smith conducted and completed a complaint investigation, with control # 31-AS-20220601123035, in regards to the facility being over capacity with (13) residents. A deficiency and citation was issued. During today's visit, the facility is once again, over capacity and Administration is not contacting LPA to discuss the concerns, during today's complaint investigation. At 11:40am, the Licensee Lidish Avetian arrived to the facility and informed LPA she was not feeling well and was sick. Licensee had a mask, but LPA was not comfortable interviewing, due to the Licensee's current condition. At this time, an additional citation will be issue, and LPA will request for a NCC (Non-Conference Conference) with management to address the concerns of the facility.

During interviews, it was disclosed to LPA, that the facility continues to lock the front gate and residents are not allowed to leave at there free will.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:
DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 01/26/2023
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This issue has been raised and discussed with both the designee and Licensee regarding the personal rights violation. At this time, LPA has determined, the facility continues to be in non-compliance and NCC (Non-compliance Conference) is now warranted.

Citations and civil penalties will be issued for over capacity. Personal rights citation will also be issued.
SUPERVISOR'S NAME: Cassandra HarrisTELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday CabinessTELEPHONE: (818) 299-4975
LICENSING EVALUATOR SIGNATURE:

DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2023
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/26/2023 02:08 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 01/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/27/2023
Section Cited

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Limitations-Capacity and Ambulatory Status-A licensee shall not operate a facility beyond the conditions and limitations...including specification of the maximum number of persons who may receive services at any one time. This requirement is not met as evidenced by:
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Caregiver and Licensee was informed that the facility is over capacity and there is needs to be a plan in place by 01/27/2023 to be in compliance pertaining to capacity.
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Based on observation, and interviews facility has thirteen residents which is more than the ten residents the facility is licensed for which poses an immediate health and safety issue for all residents in care.
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Type B
02/02/2023
Section Cited

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(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (6) To leave or depart the facility at any time and to be not locked into any building, or facility premises by
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Licensee has until the POC date to develop a plan to ensure how residents are allowed to leave the facility freely and not be locked inside the facility day and night.
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day or night. Based on interviews, residents disclosed to LPA, the facility continues to lock the front gate and not allow them to leave. This is a potential health and safety risk to residents in care.
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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: 01/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/26/2023
LIC809 (FAS) - (06/04)
Page: 3 of 3