198601566-12-13-2022-11-AS-UCOL-CPFSCE-20230227124525

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 12/13/2022
Date Signed: 12/13/2022 04:21:52 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/05/2022 and conducted by Evaluator Antonia Alvizar

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221205083824

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: 98	DATE:	12/13/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Care Coordinator Medication, Chanel Lee		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff did not dispense medications as prescribed

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Antonia Alvizar conducted an unannounced complaint visit on 12/13/2022. Upon arrival at the facility. LPA Alvizar called the facility via- phone and conducted a Risk Assessment with Chanel Lee, Care Coordinator Medication. Based on the assessment, the facility has 2 resident positive COVID-19 infection cases. LPA Alvizar met with Care Coordinator Medication, Chanel Lee and toured the facility. LPA Alvizar explained the purpose of today's visit.

The investigation consisted of the following: During the course of the investigation staff #1-#4 (S#1-S#4) and residents #1-#10 (R#1-R#10) were interviewed. Allegation: Staff did not dispense medications as prescribed. Care Coordinator Medication, Chanel stated, “No, I am always ordering medication to be refilled” 0 out of 3 Staff agreed with the allegation.

Continue on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

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 11-AS-20221205083824

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: STUDIO ROYALE	FACILITY NUMBER: 198601566
	VISIT DATE: 12/13/2022

NARRATIVE

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Continuation from 9099

3 out of 4 Staff did not agree with the allegation. 1 out of 4 Staff did not know anything about allegation. Staff (S#2 -S#3) do not agree with the allegation. S#2 stated, “No, we always give the medication unless the medical is waiting for approval from the doctor”. S#4 stated, “I don’t know anything about that because it is not my department, I only clean” 1 out of 10 Residents agreed with the allegation. 8 out of 10 Residents did not agree with the allegation. 1 out of 10 residents did not know anything about the allegation. R#7 Stated, “Yes, It has happened a couple of times but later Med-Tech give me the missed medication, not a big deal” R#1 stated, “No, staff always dispense it as far as I know”. R#4 stated, “I don’t know anything about that because Med-Tech bring me the medication”.

Investigation revealed the following: Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegations. Although the allegations 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.

A copy of the Complaint Investigation Report LIC 9099 and LIC9099-C was provided to Care Coordinator Medication, Chanel Lee.

There were no deficiencies cited.

An exit interview was conducted.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonia Alvizar	TELEPHONE: (323) 516-4092
LICENSING EVALUATOR SIGNATURE:	DATE: 12/13/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/13/2022

LIC9099 (FAS) - (06/04)

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