<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
COMPLAINT INVESTIGATION REPORT
Facility Number:
197609666
Report Date:
04/09/2022
Date Signed:
04/09/2022 01:31:04 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
06/04/2020
and conducted by Evaluator
Wendell Smith
COMPLAINT CONTROL NUMBER:
31-AS-20200604112027
FACILITY NAME:
ROYALTY ASSISTED LIVING II
FACILITY NUMBER:
197609666
ADMINISTRATOR:
AVETIAN, LIDUSH
FACILITY TYPE:
740
ADDRESS:
17326 LOS ALIMOS ST
TELEPHONE:
(818) 436-9088
CITY:
GRANADA HILLS
STATE:
CA
ZIP CODE:
91344
CAPACITY:
6
CENSUS:
5
DATE:
04/09/2022
UNANNOUNCED
TIME BEGAN:
12:00 PM
MET WITH:
Pauline Dache
TIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility did not safeguard resident's personal property.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Wendell Smith conducted an unannounced subsequent visit to finish investigation into the allegation above. LPA met with administrator and explained the reason for this visit.
It is alleged that when resident # 1(R1) passed away and R1's family came to pick up R1's belongings that specific clothing of R1's was missing. LPA conducted interviews with R1's family member and the administrator regarding this allegation. LPA obtained and reviewed R1's personal property ledger. Information from interviews revealed that R1's family did not have anything to do with R1's placement at the facility and R1's family had never been to the facility prior to R1's passing. It appears that R1 filled out their personal property list. Based on the information obtained through interviews and documentation there is not enough information to state the facility did not safeguard R1's property therefore this allegation is deemed Unsubstantiated at this time. Exit Interview conducted.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME:
Cassandra Harris
TELEPHONE:
(818) 596-4342
LICENSING EVALUATOR NAME:
Wendell Smith
TELEPHONE:
(818) 738-4525
LICENSING EVALUATOR SIGNATURE:
DATE:
04/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
04/09/2022
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
2