197609001-1-26-2023-31-AS-EMIR-CNNRLB-20230202120653

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609001
Report Date: 01/26/2023
Date Signed: 01/26/2023 01:47:17 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
01/20/2023 and conducted by Evaluator Tuesday Cabiness

PUBLIC

COMPLAINT CONTROL NUMBER: 31-AS-20230120123514

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: 11	DATE:	01/26/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Kara Charchaogalyan		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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1. Facility staff gave resident medication to sedate them
2. Facility staff did not report resident's hospitalization to resident's family
2. Facility phone is non operational

INVESTIGATION FINDINGS:

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Licensing Progam Analyst (LPA) Tuesday Cabiness conducted an initial complaint investigation, pertaining to the allegtions mentioned above. LPA met caregiver Kara Charchaoglyan and informed her the reason of the visit. Licensee Lidush Avetian arrived at the facility at 11:40am, but was not feeling well and sick, and left the facility. The following was determined:

Allegation # 1: On 01/25/2023 and 01/26/203 from various times between 9am to 2pm, LPA interviewed the complainant and attempted to interview a witness pertaining to the allegations. LPA was not succesful with interviewing the witness. During today's visit, from 10am to 230pm, LPA interviewed residents, staff, resident #1 (R1), and obtained documentation pertaining to the complaint. It was reported (R1) often appears to be overly medicated and sedated during visits unnannounced. During today's visit, LPA interviewed R1, who reported the reason why R1 appears to be incoherent. Although it was reported that R1 appears to be overly medicated, LPA was not able to interview the witness and there was no mandated reporting report (SOC341) submitted or cross reported to Licensing regarding the concerns of R1 appearing to be overly medicated and incoherent

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (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.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20230120123514

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: 01/26/2023

NARRATIVE

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During today's interviews, all residents reported, they receive medication on time by staff on duty. LPA reviewed medication records and there appeared to be no issues or concerns during today's visit. Therefore, based on interviews and records reviewed, LPA had insufficient evidence to corroborate the allegation, and it is UNSUBSTANTIATED at this time.

Allegation # 2: Facility staff did not report resident's hospitalization to resident's family. On 01/25/2023 and 01/26/203 from various times between 9am to 2pm, LPA interviewed the complainant and attempted to interview a witness pertaining to the allegations. LPA was not successful with interviewing the witness. On 01/26/2023, from 10am to 230pm LPA interviewed resident #1 (R1), other residents, staff, and conducted a physical plant inspection. It was reported to LPA by R1, R1 has not been hospitalized in a long time, and does not remember the last time. Staff reported to LPA, that R1 has not been hospitalized for about a year, and LPA reviewed incident reports, and there was no documentation pertaining to R1. Therefore, LPA has insufficient evidence to corroborate the allegation, and based on interviews, and it UNSUBSTANTIATED at this time.

Allegation # 3: Facility phone is non-operational. On 01/25/2023 and 01/26/203 from various times between 9am to 2pm, LPA interviewed the complainant and attempted to interview a witness pertaining to the allegation. LPA was not successful with interviewing the witness. On 01/26/2023, from 10am to 230pm, LPA interviewed residents, staff, and conducted a physical plant inspection. It was reported to LPA by the complainant, that the allegation facility phone is not operational was incorrect, and a mistake, but wanted Licensing to be aware, that there are times when staff hang up or do not answer the phone in a timely manner. During today's visit, LPA called the facility phone, it was answered by caregiver Kara, and during the visit, LPA overheard several times, facility phone ringing and being answered by staff. Therefore, based on observations and interviews, the allegation is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Cassandra Harris	TELEPHONE: (818) 596-4342
LICENSING EVALUATOR NAME: Tuesday Cabiness	TELEPHONE: (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

LIC9099 (FAS) - (06/04)

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