197609001-11-15-2024-31-AS-NMAN-DBWN4U-20241213090832

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609001
Report Date: 11/15/2024
Date Signed: 11/15/2024 01:35:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.ASC, 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
11/13/2023 and conducted by Evaluator Nicholas Reed

COMPLAINT CONTROL NUMBER: 31-AS-20231113085558

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: 9	DATE:	11/15/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Olga Rodriguez		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Staff handled resident in care in a rough manner
Staff threw resident's phone away
Staff did not clean resident's room
Children present in the facility pose a risk to residents in care

INVESTIGATION FINDINGS:

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At 9:30 a.m. on 11/15/24 Licensing Program Analyst (LPA) Nicholas Reed conducted an unannounced complaint visit. LPA met with staff and later the administrator and disclosed the reason for the visit.

To investigate the allegations above, LPA Christopher Alemoh conducted an initial visit on 11/16/23 and interviewed one (01) out of three (03) staff and seven (07) out of nine (09) residents and collected and reviewed records including but not limited to physician reports, appraisal needs and service plan, admission agreements, and the Client Roster between 3:00 p.m. and 5:00 p.m. LPA Alemoh conducted a subsequent visit on 01/23/24 and conducted a physical plant tour at 9:35 a.m., requested copies of facility documents relevant to the investigation at 10:20 a.m., and interviewed residents and staff between 10:50 a.m. to 3:00 p.m. Today, LPA Reed interviewed five (05) out of nine (09) residents and one (01) staff between 10:00 a.m. and 11:15 a.m., toured the facility at 10:15 a.m., and reviewed records including but not limited to face sheets and physician reports at 11:30 a.m.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024

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-20231113085558

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: ROYALTY ASSISTED LIVING	FACILITY NUMBER: 197609001
	VISIT DATE: 11/15/2024

NARRATIVE

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Regarding the allegation "Staff handled resident in care in a rough manner" it was alleged the administrator pulled the arm of Resident #1 (R1) and hurt them on 11/11/23. Interview with the administrator today at 10:15 a.m. revealed they nor any other staff have hurt or handled any residents roughly. Interviews with Staff #1 (S1) at 10:00 a.m. today and five (05) out of five (05) residents present in the facility confirmed that no staff have hurt residents. No residents recalled staff pulling R1’s arm. No records were available indicating staff harmed R1 on 11/11/23. Based on observations, record review, and interviews, there is insufficient evidence to prove staff handled R1 in a rough manner. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Regarding the allegation "Staff threw resident's phone away " it was alleged the administrator grabbed R1’s phone and threw it. Interview with the administrator revealed they never threw R1’s phone. Interviews with S1 and five (05) out of five (05) residents revealed they had never seen any staff throw R1’s phone or anyone else’s phone. No residents or staff recalled the encounter between R1 and the administrator. LPA observed the administrator and S1 treating residents respectfully today. No records were available indicating staff threw R1’s phone. Based on observations, record review, and interviews, there is insufficient evidence to prove staff threw R1’s phone. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Regarding the allegation "Staff did not clean resident's room” it was alleged staff do not clean R1’s room. Interview with S1 revealed they clean all rooms in the house every day. R1 instructed S1 to not clean their room. LPA observed R1’s room during the plant tour. R1’s room appeared to be clean. Other resident rooms, bathrooms, and common areas were clean as well. Interviews with the administrator and five (05) out of five (05) residents revealed the facility is clean to their likings. Based on observations and interviews, staff clean all rooms, have offered to clean R1’s room, and have respected R1’s preference. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Regarding the allegation "Children present in the facility pose a risk to residents in care" it was alleged S1 took their children to the facility on 11/12/23 and they were annoying. Interview with S1 revealed they had brought their granddaughter to the facility for an hour on one occasion. No residents had issue with the granddaughter present. The granddaughter was supervised and had contact with residents. Interviews with five (05) out of five (05) residents revealed they did not recall any children present in the facility. LPA Reed did not observe any children present today. LPA Alemoh did not observe any children present on 11/16/23 or 01/23/24. Based on observations and interviews, no children present posed a risk to residents in care. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.
Exit interview conducted. Copy of report provided.

SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: Nicholas Reed
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024

LIC9099 (FAS) - (06/04)

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