197602857-2-26-2025-29-AS-KHEN-DEC8FZ-20250228212933

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197602857
Report Date: 02/26/2025
Date Signed: 02/26/2025 01:07:55 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/12/2024 and conducted by Evaluator Emily Peraldi

COMPLAINT CONTROL NUMBER: 29-AS-20240312085646

FACILITY NAME:	ROYAL GARDEN		FACILITY NUMBER:	197602857
ADMINISTRATOR:	KIGEL, ALEKSANDR		FACILITY TYPE:	740
ADDRESS:	6159 ATOLL AVE		TELEPHONE:	(818) 909-0210
CITY:	VALLEY GLEN	STATE: CA	ZIP CODE:	91401
CAPACITY:	6	CENSUS: 3	DATE:	02/26/2025
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Sophia Labendze, Licensee		TIME COMPLETED:	01:20 PM

ALLEGATION(S):

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Staff hit a resident resulting in an injury.
Staff made inappropriate comments towards a resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced subsequent complaint visit to this facility to deliver findings. At 10:30 a.m., the LPA met with staff and explained the reason for the visit. At 11:20 a.m., the Licensee, Sophia Labendze arrived at the facility.

During the initial visit conducted on 03/13/2024 between 12:26 p.m. and 2:30 p.m., the LPA conducted a physical plant tour and conducted an interview with the Licensee. During the initial visit, the LPA also requested and obtained copies of pertinent documents. On 02/26/2025, the LPA conducted a collateral visit to interview Resident #1 (R1). On 02/26/2025, the LPA conducted a telephonic interview with R1’s family member. During todays visit between 10:38 a.m. and 11:20 a.m., the LPA conducted a physical plant tour and conducted interviews with the Licensee, three (3) residents and three (3) staff.

Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

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 29-AS-20240312085646

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ROYAL GARDEN	FACILITY NUMBER: 197602857
	VISIT DATE: 02/26/2025

NARRATIVE

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Regarding the allegation: 1.) Staff hit a resident resulting in an injury. It was alleged that Staff #1 (S1) hit Resident #1’s (R1’s) forearm with a closed fist on 03/04/2024. Interview conducted with R1’s family member stated that R1 had a bruise from the alleged incident, however R1’s family member did not take a picture of the bruise since R1 was in the process of moving out of the facility. Interviews conducted with the Licensee and staff, including S1 denied the allegation and denied that any staff ever hit residents. Interview with the Licensee explained that she did not observe bruising on R1’s forearm during the time of the incident. Residents interviewed denied being treated poorly or being hit by staff. The information obtained during interviews and the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Regarding the allegation: 2.) Staff made inappropriate comments towards a resident. It was alleged that S1 made two inappropriate comments towards R1. Staff interviews, including S1 denied speaking inappropriately towards R1. Staff interviews revealed that no staff have ever heard staff be disrespectful or rude to the residents. Interviews with residents did not voice any concerns regarding staff and stated that staff are respectful towards them. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Exit interview conducted a copy of the report was provided.

SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2025

LIC9099 (FAS) - (06/04)

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