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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601566
Report Date: 02/17/2023
Date Signed: 02/17/2023 12:22:49 PM


Document Has Been Signed on 02/17/2023 12:22 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:STUDIO ROYALEFACILITY NUMBER:
198601566
ADMINISTRATOR:TERRI WEITZMANFACILITY TYPE:
740
ADDRESS:3975 OVERLAND AVENUETELEPHONE:
(310) 836-5854
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:175CENSUS: 91DATE:
02/17/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Chanel LeeTIME COMPLETED:
12:00 PM
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On 02/17/2023, Licensing Program Analyst (LPA) Wendy Gibbs conducted an unannounced annual required visit with a primary focus on Infection Control measures. LPA met with Resident Care Coordinator, Chanel Lee and explained the purpose of today’s visit. The facility is licensed to operate for 175 elderly residents ages 60 and above of which five (5) can be bedridden on the first floor and 74 non-ambulatory. The facility is approved for five (5) hospice. Currently there are 91 residents. The facility has no memory care unit.
Structure The facility is a two-story building in a business area. There is a total of 35 resident rooms on the first floor and 57 rooms on the second floor. There is a parking area in the front and side of the facility. The lobby/receptionist area is located as you enter the building. There are two common bathrooms on each floor. The activity room is located on the first floor. The dining room is located on the first floor. The TV/Movie room are located on the first floor. The staff break room is located on the first floor. The library is located on the second floor with a computer accessible for residents.
Physical Plant LPA and Resident Care Coordinator toured the physical plant. There is an outside patio area with canopies and tables with chairs all along the perimeter. All walkways were clean, clear and free of obstructions, debris and hazards. There were no bodies of water on the premises. The elevator was last inspected and serviced on 10/27/22.
Bedrooms Various rooms were inspected during the visit including 127, 133, 140 144, 132, 217, 218, 211 and 207. Residents have the option to furnish their rooms, or they have beds, dressers and nightstands provided. All rooms had the required furniture, including bed, dresser, and nightstand. All beds were in good condition and had the required linens including a mattress cover, fitted sheets, blankets, comforter and pillows. All rooms had ample lighting provided. All residents had adequate storage for resident personal belongings.
Linens LPA observed an ample supply of mattress covers, bed linens, comforters, and bath towels were adequately stocked in a locked storage room. Residents get fresh towels daily.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy GibbsTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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