198601566-2-17-2023-11-AS-WGIS-CP5S4W-20230217123324

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601566
Report Date: 02/17/2023
Date Signed: 02/17/2023 12:33:30 PM

Document Has Been Signed on 02/17/2023 12:33 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 ROYALE		FACILITY NUMBER:	198601566
ADMINISTRATOR:	TERRI WEITZMAN		FACILITY TYPE:	740
ADDRESS:	3975 OVERLAND AVENUE		TELEPHONE:	(310) 836-5854
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY:	175	CENSUS: 91	DATE:	02/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Chanel Lee		TIME COMPLETED:	12:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	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 Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: STUDIO ROYALE	FACILITY NUMBER: 198601566
	VISIT DATE: 02/17/2023

NARRATIVE

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Bathrooms All resident rooms have their own bathrooms. Bathrooms were found to be within Title 22 regulations and were clean and operational. All bathrooms observed had good working faucets, toilets, and showers. All safety handrail bars were securely attached. All showers had either a shower chair or nonskid material on the bottom. Water temperature measured between 110.8-degrees and 117.1-degrees Fahrenheit.
Kitchen The kitchen was inspected, and LPA observed a 4-day supply of perishable and a 7-day supply non-perishable food available and maintained properly. There is a walk-in refrigerator and freezer fully stocked in the kitchen. Food deliveries are made to the facility every Tuesday and Thursday of every week.
Common Rooms LPA walked through all common spaces. In the dining room LPA observed seating available for all residents. In the activity room there is enough room to accommodate residents. A comfortable temperature was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. All walkways were clean, clear and free of obstructions and hazards. There was ample lighting in all walkways and common rooms.
Medications Medication room is located on the second floor of the facility and was inspected. LPA reviewed 4 residents’ medications and matched them to the MARs.
Files LPA reviewed 5 resident files and found they contained the required documents. LPA reviewed 4 staff files and found they contained the required documents, training and certification.
Emergency LPA observed multiple fire extinguishers throughout the facility last serviced on 09/22/22. The fire alarm and sprinkler system were just last serviced on 02/16/23. There are fire door throughout the facility that close automatically when alarms go off. The last emergency drill was conducted on 02/08/23. LPA inspected the First Aid kit and found it contained the required items and a manual. All residents’ rooms and bathrooms have a call system, if they need assistance, that rings at the front desk and Resident Care Coordinator’s office. LPA observed all the required postings.
Infection Control During the visit, LPA observed the facility infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, LPA observed the facility has a minimum 30-day supply of Personal Protective Equipment (PPE) available. There are infection control signs posted.
LPA viewed the Liability Insurance.
No other deficiencies were cited during this inspection visit.

An exit interview was conducted and a copy of this report was provided to Chanel Lee.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (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

LIC809 (FAS) - (06/04)

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