Victor Royale, Llc

Licensing Program Analyst (LPA) Angelica Rea conducted a visit in response to the above allegation. On today's visit, LPA met with Administrator, Peter Babaian who assisted with today's visit. Regarding the allegation that facility does not have all required posted signs in the facility, the investigation consisted of : Interview with Administrator, Staff #1, as well as facility tour and review of facility wall posting(s). Administrator and Staff #1 stated that they recently removed some of the posted signs, because they were redecorating the facility, and adding wall paper to the facility. Administrator stated that the redecorating was completed approximately 2-3 months ago. LPA observed that the Ombudsman poster was posted on a white board in the hallway. LPA observed that all required postings were not posted on today's visit : Residents' Rights, Community Care licensing report(s), Resident council information, non discrimination notice, and admission agreement was not posted, nor wRead the full finding— CDSS inspection report, August 8, 2022 · control 28-AS-20220801153004

Licensing Program Analyst (LPA) V. Maldonado made a subsequent unannounced complaint visit at the facility regarding the above mentioned allegations. LPA Maldonado met with assistant Administrator Alise Nazarian and Administrator Peter Babaian, and explained the purpose for the visit. During today's visit, LPA Maldonado toured the physical plant with assistant administrator Alise Nazarian. A copy of the resident and staff roster were requested, as well as a copy of the following documents for Resident# 1 (R1): Admission's agreement, Physician's report, identification and emergency information, Preplacement Appraisal, Needs and Services Plan, Medication Administration Records (MARs) for September 2020, and the Plan of Operations- Absentee Notification Plan for Missing Residents. Administrator, assistant adminstrator, Staff# 1 (S1), and Residents# 2-6 (R2-R6) were also interviewed. Report Continued on LIC9099-C... UnsubstantiatedRead the full finding— CDSS inspection report, August 5, 2022 · control 28-AS-20200909154000

On 7/21/22 at 9:30 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint visit to the facility. Upon arrival, LPA met with S1 and explained the purpose of the visit. At 10:15 Administrator Peter Babaian joined the visit. The investigation consisted of the following: During today’s visit LPA toured the facility with S1, obtained the resident/ staff roster, and obtained a copy of S1-S6 LIC-602. The investigation reveals the following: Regarding “staff is not assisting residents with medical appointments”, it is alleged that residents have not received a second booster. 6/6 residents confirmed staff assists residents with medical appointments and COVID vaccinations. Report Continued on LIC9099c UnsubstantiatedRead the full finding— CDSS inspection report, July 21, 2022 · control 28-AS-20220714083638

Licensing Program Analyst (LPA) Calderon initiated a subsequent unannounced complaint investigation for the allegations listed above. LPA met with Administrator Peter Babian and explained the purpose of the visit which was to deliver investigation findings. On 03/24/21, LPA Tao conducted a telephonic initial visit, during visit, LPA interviewed Staff #1, Staff #2, Staff # 3, and Resident #1 and obtained copies of resident roster and staff schedule. LPA Tao requested copies of the following documents, Resident#1’s (R1) Face sheet, physician report, admission agreement, appraisal -needs and services plan, incident reports for March 2021 related to R1, training logs regarding residents’ rights, wound care, first aid, residents being bullied and staff #1’s &#2 first aid certificates. Continued on LIC 9099-C UnsubstantiatedRead the full finding— CDSS inspection report, July 15, 2022 · control 28-AS-20210319083138

Licensing Program Analyst (LPA) Luis Mora conducted an unannounced complaint visit to determine the validity of the above-mentioned allegations. LPA met with Administrator Peter Babaian and explained the reason for the visit. The investigation consisted of the following: LPA obtained a copy of the residents and staff rosters, conducted a tour of the facility and interviewed the Administrator, Staff 1 - Staff 3 (S1 - S3) and Resident 1 - Resident 6 (R1 - R6). The investigaion revealed the following: regarding the allegation "staff did not keep resident's bathroom clean & sanitary", it is alleged that S2 refused to clean smeared feces in a private bathroom inside a shared resident bedroom. Other staff were asked to do it, but also refused. The administrator and staff interviewed denied the allegation and stated that none of the staff have denied to clean any bathroom. (CONTINUED TO LIC 9099C) UnsubstantiatedRead the full finding— CDSS inspection report, July 12, 2022 · control 28-AS-20220707144303

On the above date, Licensing Program Analyst (LPA) Christine Wong conducted an intiail 10 days complaint which included the 24 hours healthy and safety check. LPA met with Assistant Administrator Alise Nazarian and explained the reason of the visit and she also assisted LPA with the visit. The investigation consisted of the following: A physical plant tour of the facility was conducted. No health and safety issues were observed. LPA also interviewed seven residents (R1-R7), administrator and five staff (S1-S5) and also obtained copy of residents roster, staff roster and incident report for R1 and reviewd the residents' diaper changing log book The investigation revealed of the following: Allegation#1 " Staff hit resident." LPA interviewed seven residents and six out of seven residents denied the allegation and reported they never seen any staff hit resident. LPA interviewed the victim and also denied any staff was hitting him in the facility and reported it never happened. (See LIC 909Read the full finding— CDSS inspection report, June 30, 2022 · control 28-AS-20220628163253

On 6/21/22 at 10:05 a.m., Licensing Program Analyst (LPA) Jewel Baptiste conducted an unannounced complaint visit to the facility. Upon arrival LPA met with Peter Babaian(Administrator) and explained the purpose of the visit. Investigation consisted of the following: During today’s visit LPA toured the facility with assistant administrator, obtained resident/ staff roster, remodeling invoice dated 10/26/2021- 2/10/22 and photo of remodeling sign posted outside dining room. LPA interviewed residents R1- R7. LPA Interviewed administrator, Staff S1- S3. The investigation reveals the following: In regard to "Staff does not post Ombudsman poster.", it is alleged that the facility does not have the Ombudsman poster posted in the facility. During the visit LPA toured the facility and was not able to locate the Ombudsman poster. LPA observed a signed posted by dining room confirming remolding started August 16th, 2021. Administrator confirmed poster was removed during facility remodeling on MaRead the full finding— CDSS inspection report, June 21, 2022 · control 28-AS-20220615161924

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA Flores met with Peter Babaian Administrator and explained the reason for the visit. The investigation consisted of the following: LPA Flores requested a copy of staff/resident roster. LPA interview resident #1(R1),#2(R2),#3(R3),#4(R4),#5(R5),#6(R6), administrator, staff #2(S2),#3(S3),#4(S4). Requested copies of identification and emergency information sheet, physician's report, appraisal/needs and service plan for R1,R2,R3,R4,R5 and assisted living waiver(ALW) individual service plan (ISP) for R1 from resident's files. The investigation revealed the following: Regarding allegation: Residents are not allowed to participate in their appraisal needs and services plan. It is alleged staff have not included resident in decision making regarding appraisal needs and service care plan. (CONTINUED ON LIC 9099C) UnsubstantiatedRead the full finding— CDSS inspection report, June 21, 2022 · control 28-AS-20220616144854

Licensing Program Analyst (LPA) Angelica Rea conducted an unannounced complaint visit in response to the above allegations. LPA met with Administrator, Peter Babaian who assisted with today's visit. Regarding the allegation that the facility refused to comply with resident #1's physician's report, the investigation consisted of Review of Resident #1's physician report, and Interview(s) with Administrator, Staff #1, Staff #2, and Resident #1 - Resident #5. Administrator and Staff interviewed stated that resident #1 resides in a cottage which is located behind the main building. Administrator and staff interviewed stated that the cottages are for ambulatory residents. Staff stated that resident #1's physician report dated 4/19/22 states that he is ambulatory, however he has been using a walker for the last couple of months due to reduced mobility. Staff indicated that they would prefer resident #1 move to the main building for his safety. However, they are not going to move resident #1 aRead the full finding— CDSS inspection report, May 4, 2022 · control 28-AS-20220429103611

Licensing Program Analyst (LPA) Nune Margaryan conducted a subsequent complaint visit to deliver findings on the allegations listed above. LPA met with administrator Peter Babaian and explained the purpose of today's visit. An initial 10-day telephonic complaint visit was conducted on 12/28/2020 by Licensing Program Analyst (LPA) P. Rivas. A subsequent complaint visit was conducted on 12/10/2021 by LPA N. Margaryan. During the visit LPA Margaryan conducted interviews with the administrator, facility staff and residents regarding the allegations listed above. Continue 9099C Unsubstantiated— CDSS inspection report, April 14, 2022 · control 28-AS-20201218154545

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA Flores met with Peter Barbarian administrator and explained the reason for the visit. The investigation consisted of the following: On 1/11/22 LPA Flores conducted initial visit and requested copies of resident and staff roster. LPA Flores observed facility's cordless telephone at front desk, pay phone in patio, pay phone at cottage accessible to residents in working condition. LPA interview residents #1(R1), #2(R2), #3(R3), #4(R4), #5(R5). LPA Flores requested copies of facility phone bills for the last 3 months to be email to LPA by end of day. On 4/11/22 LPA Flores requested copies of phone bills for the months of November 2021 - February 2022 and interviewed Staff #1(S1),#2(S2),#3(S3),and#4(S4). (CONTINUED LIC 9099C) UnsubstantiatedRead the full finding— CDSS inspection report, April 11, 2022 · control 28-AS-20220104154426

Licensing Program Analyst(s)(LPA) Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA Flores met with Peter Barbaian and explained the reason for the visit. The investigation consisted of the following: LPA Flores requested copies of staff/resident roster, Resident #1(R1) 30 day notice, admission agreeement, physician's report, appraisal needs and care plan, notices for room change. LPA Flores interviewed resident #1(R1),#2(R2),#3(R3),#4(R3),#5(R5),#6(R6) administrator, staff #2(S2),#3(S3),#4(S4). The investigation revealed the following: Regarding allegation; Resident was not provided with a 30 day notice to change rooms. It is alleged resident was not provided with a 30 day notice to change rooms. (CONTINUED LIC 9099C) UnsubstantiatedRead the full finding— CDSS inspection report, April 11, 2022 · control 28-AS-20220405121014

Licensing Program Analyst (LPA) Christine Wong conducted an unannounced complaint visit to investigate the above allegations. LPA met with LVN-Amy Smbatuni and explained the reason of the visit. Shortly after, the administrator Peter Babaian arrived. The investigation consisted of the following: LPA toured the kitchen and dining room. LPA interviewed six (6) residents (R1-R6) and administrator and four (4) staff (S1-S4) and obtained copy of the resident and staff roster and the menu for the week. The investigation revealed of the following: Allegation#1 "Staff are not providing adequate food service for residents." LPA interviewed six (6) residents and five (5) residents reported they always get enough food in the facility. They can have second plate if they want and they can get substitue choices if they do not like the food on the meun of the day. They were never being hungry or starving in the facility. (See LIC 9099C for continuation) UnsubstantiatedRead the full finding— CDSS inspection report, March 21, 2022 · control 28-AS-20220318101341

Licensing Program Analyst (LPA) Alma Gonzalez conducted an unannounced complaint visit to gather information pertaining to the above-mentioned allegation. LPA met with Administrator Peter Babaian and explained the reason for the visit. The investigation consisted of: LPA conducted interviews with Administrator Peter Babaian, Assistant Administrator Alice Nazarian, Staff 1 (S1) and Residents 1-5 (R1-5). LPA requested and received copies of Staff and Resident Rosters. LPA reviewed R1's file and obtained copies the following documents: Admission Agreement, Resident Appraisal dated 1/1/21, Identification and Emergency Information dated 3/5/21, Physician's Report for Residential Care Facilities for the Elderly (RCFE) LIC602A dated 5/19/21, Appraisal/ Needs and Services Plan dated 1/1/21 and 1/1/22, Two letters addressed to R1 dated 3/10/22 and 3/15/22, Unusual Incident/ Injury Report LIC624 dated 2/28/22 and 3/25/21. LPA also conducted a tour of facility which included observations of commoRead the full finding— CDSS inspection report, March 15, 2022 · control 28-AS-20220310140032

Licensing Program Analyst (LPA) Trueman conducted a complaint visit to investigate the allegation listed above. LPA met with Administrator, Peter Babaian and explained the reason for the visit. The kitchen was toured at 12:45 PM along with Assistant Administrator Alice Mazarian and the menu for 2/27 to 3/5 was posted and a sufficient supply of perishables and non-perishables were observed. Reception desk was toured and included a binder containing menus. From 12:30 PM to 1:15 PM Staff S1- S4 were interviewed. From 1:10 PM to 1:30 PM Resident R 1 was interviewed telephonically. In regards to the allegation Facility is not keeping copies of the last 30 days of menus,during tour LPA observed a binder containing menus from 1/30 to 3/5. Staff interviewed stated binder is always kept with 6 weeks of past menus available for review and menu for current week is posted by dining room. Resident 1 stated that he wants to review past 30 days of menus and if there are 6 weeks in binder that is goodRead the full finding— CDSS inspection report, March 2, 2022 · control 28-AS-20220222160553

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegation. LPA met with Peter Babaian and explained the reason for the visit. The investigation consisted of the following: LPA obtained copies of Staff and Resident Rosters. LPA also reviewed Resident #1 (R1's) file and obtained copies of the following documents: Copy of Insurance Card, Physician's Report, ID Emergency Information, Resident Appraisal, and Needs & Services Plan. LPA also interviewed Staff #1 - Staff # 2 and Resident #1 (R1) - Resident #5 (R5). The investigation revealed the following: in regards to the allegation "facility administration is telling the resident he has to change his insurance to their insurance", it is alleged that facility administrators are telling a resident that he must change his insurance to the facility insurance company. It is alleged that this resident would lose his dental and vision insurance if the change is made and would haveRead the full finding— CDSS inspection report, February 15, 2022 · control 28-AS-20220208095038

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint visit to the facility. Upon arrival, LPA met with Peter Babaian (Administrator) and explained the purpose of the visit. During today's visit, LPA obtained a copy of the Staff schedule and Resident roster. LPA interviewed Staff #1 in the office at 10:20 am and interview Resident #2 and #3 in their bedrooms between 10:40 am to 11:10 am. In regards to the allegation: Lack of supervision resulting in inappropriate interactions between resident's. A review of the Staff schedule indicate Staff is sufficient on the date of the incident. There is one night staff on duty and 3 staff on call which can arrived to the facility within 10 minutes if notified. Interviews with Resident and Staff revealed that on the night of the incident, Resident #3 was in Resident #2's bedroom for a cigarette. There is no indication that Residents engaged in any type of inappropriate interactions. Continue to LIC9099C...... UnsubstantiatedRead the full finding— CDSS inspection report, February 7, 2022 · control 28-AS-20220203150134

/22/2021 Licensing Program Analyst (LPA) Nina Galarza conducted an unannounced subsequent visit regarding the allegations listed above. LPA met with staff, Amy Smbatuni and stated the purpose of the visit. LPA later met with Administrator Peter Babaian and stated the purpose of the visit. On 12/15/2021 LPA toured the facility with Staff#1(S1). The investigation consisted of the following; On 12/15/2021, interviews with Administrator, Staff #1-5(S1-S5) and Residents #1-5(R1-R5). On 12/15/2021 LPA obtained copies of staff roster, resident roster, face sheet for R1-R5, admission agreement and house rules. On 12/22/2021, interviews with Administrator and R1- R5. On 12/22/21 LPA obtained copies of staff roster, resident roster, facility sketch, and notice of construction. CONTINUED 9099-C UnsubstantiatedRead the full finding— CDSS inspection report, December 22, 2021 · control 28-AS-20211209150317

Licensing Program Analyst (LPA) Nicole Spencer conducted a subsequent complaint visit regarding the allegations listed above. LPA Spencer was met by administrator Peter Babaian and explained the purpose of today's visit. The investigation consisted of the following: During the initial visit on 7/20/21, LPA Spencer took a tour of the physical plant and interviewed the administrator, staff #1-4 (S1-S4) and residents #1-6 (R1-R6). LPA attempted to interview S5 but was unable to be reached and R2 was non-verbal so the interview was discontinued. LPA received copies of the staff roster, resident roster, and diapering logs for three (3) specified residents. During today's visit on 12/9/21, LPA Spencer interviewed staff #6 (S6), resident #7-9 (R7-R9), and collected copies of needs and services plan for two specified residents. ***See LIC9099C for continuation of this narrative*** UnsubstantiatedRead the full finding— CDSS inspection report, December 9, 2021 · control 28-AS-20210715162136

Licensing Program Analyst (LPA) Kruz Long conducted an unannounced complaint at the facility. Upon arrival, LPA met with Alise Nazarian and explained the purpose of the visit. Administrator Peter Babaian arrived a short time later and assisted with the complaint investigation. During today's visit, LPA obtained a copy of the Staff/Resident rosters and interviewed Staff #1 in the office at 9:39 am, interviewed Resident #1 in the office at 10:12 am, interviewed Residents #2 and #3 in the office between 10:56 am to 11:19 am and interviewed Staff #2 and #3 in the office via telephone between 11:34 am to 12:12 pm. In regards to the allegation: Staff pushed resident: LPA's interviews with Staff and Resident who were present during the time of incident was not able to corroborate Staff pushed Resident. Continue to LIC9099C........ UnsubstantiatedRead the full finding— CDSS inspection report, November 8, 2021 · control 28-AS-20211103151811

Licensing Program Analyst (LPA) Jose Villalobos conducted an unannounced complaint visit to address the above allegations. LPA met with Administrator Peter Babaian. The purpose of the visit was discussed. The investigation consisted of the following: On today's visit, LPA toured the physical plant, interviewed residents #1-#7 (R1-R7), and interviewed Staff #1-#6 (S1-S6). LPA also reviewed R1's facility file. The investigation revealed of the following: In regards to the allegation, "Staff left resident in soiled clothing for an extended period of time." it was alleged that on 10/23/21, it was observed that R1's diaper had not been changed and was left with soiled clothing. (6) of (6) staff interviewed denied the allegation. (7) of (7) clients interviewed could not corroborate the allegation. Interviews with staff show that R1 does wear a diaper but as a personal choice. Interviews state that R1 is able to use the restroom and staff frequently ask R1 if they would like assistance but R1Read the full finding— CDSS inspection report, November 4, 2021 · control 28-AS-20211027104935

Licensing Program Analyst (LPA) Linda Almaraz conducted a subsequent complaint investigation visit in regards to the allegation above. LPA was greeted by Peter Babaian and Alise Nazarian and explained the reason for todays visit. The investigation consisted of the following: On 8/27/2020, LPA Almaraz conducted telephonic interviews with Administrator, Staff #1-4, and Residents #1-4. LPA requested copies of: Staff and Resident Roster, Police report number and Incident Reports. LPA also requested video footage of the incident. On 9/15/2021, LPA requested files for Staff #2, Resident #1 and #5. LPA also attempted to interviewed Resident #5 but the resident no longer lives at the facility. The investigation revealed the following: Based on interviews conducted, on 8/19/2020, Staff #2 was near a reception area when Resident #1 came by and was standing near the area. Staff #2 stated that Resident #1 was trying to enter the back of the reception area and told Resident #1, resident could not gRead the full finding— CDSS inspection report, September 15, 2021 · control 28-AS-20200819155029

Licensing Program Analysts (LPAs) Cynthia Chan and Nune Margaryan conducted a complaint investigation for the allegation listed above. LPAs met with Alise Nazarian, Assistant Administrator and explained the purpose of the visit. LPAs interviewed the Administrator, Assistant Administrator, 3 Staff, and 6 Residents. LPAs obtained a copy of the Staff and Resident rosters, and documents for Resident #1 (R1): Face Sheet, Preplacement Appraisal Information, Physican's Report, Appraisal/Needs and Services Plan, Medication log from January - June 2021, and facility notes. Resident #1 has not returned to the facility since 6/11/21 and was not interviewed. In regards to allegation - Staff did not assist resident with receiving medication. According to interviews with the Administrator, Assistant Administrator, and 1 Staff, they were aware of Resident #1's (R1) refusal of medication. Staff interviewed noticed that R1's behavior was becoming more agressive than usual and the refusal of medicationsRead the full finding— CDSS inspection report, July 20, 2021 · control 28-AS-20210713094059

Licensing Program Analyst (LPA) David Sicairos conducted an unannounced complaint visit regarding the above stated allegation. LPA met with Alise Nazarian and explained the reason for the visit. Administrator Peter Babian arrived shortly thereafter. The investigation consisted of the following: LPA toured the facility and obtained Staff & Resident Rosters. LPA reviewed the LPA also interviewed the Administrator and Staff #1 - Staff #2. The investigation revealed the following: in regards to the allegation "facility is not conducting fire drills", it is alleged that since the facility was last cited for this same allegation back in 2020, the facility has only conducted 1 fire drill. Per interview with Administrator, the last drill was conducted on 04/23/21 in the afternoon shift. However, Administrator was unable to provide documentation of said drill. (CONTINUED ON 9099C) SubstantiatedRead the full finding— CDSS inspection report, July 15, 2021 · control 28-AS-20210707161111

Licensing Program Analysts (LPAs) Elizabeth Irra and Nune Margaryan conducted the initial 10-day complaint visit to investigate the above allegation. LPAs met with the Assistant Administrator and discussed the purpose of today's visit. The Facility Administrator arrived at approcximately 10:20 A.M. and assisted with this visit. During today's visit, LPAs interviewed the Assistant Administrator (S-1), Facility Administrator (S-2), Licensed Vocational Nurse (S-3), Activities Director (S-4) and Housekeeper (S-5). LPAs also interviewed Resident #1 (R-1) through Resident #5 (R-5) and reviewed Residents files. Refer to LIC 9099C for the continuation of this report. SubstantiatedRead the full finding— CDSS inspection report, July 7, 2021 · control 28-AS-20210629083147