198601566-6-1-2023-11-AS-SCIS-CW2Q4P-20230926115041

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 05/30/2023
Date Signed: 06/01/2023 08:38:47 AM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
05/22/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20230522120849

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: 92	DATE:	05/30/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Guerrero (Willie) Wilford		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility bathrooms are in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Tuesday, May 30, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Health Wellness Director Wilford (Willie) Guerrero. LPA Bunker explained the purpose of today's visit.
The investigation consisted of the following: LPA Bunker conducted interviews with staff member 1 (S1) and residents (R1-R10) regarding the nature of the complaint. Relevant questions were asked by LPA Bunker to gather necessary information. LPA Bunker and Mr. Guerrero, conducted a through inspection of the facility's public restrooms on both the downstairs and upstairs levels. It was found that the restrooms on the first floor were temporarily out of order. Additionally, the individual bathrooms of the residents were inspected, and it was confirmed that they were in proper operational condition, with functioning toilets. R1-R10 interviewed reported no issues with their bathroom toilets. LPA Bunker requested copies of supporting documents. Nurse Wilford provided LPA Bunker with copies.
See the continued LIC9099-C page 2

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 11-AS-20230522120849

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 05/30/2023

NARRATIVE

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Continued LIC9099-C page 2

Allegation: Facility bathrooms are in disrepair
Staff 1 (S1) and residents 1-10 (R1-R10) were interviewed regarding the facility bathrooms being in disrepair. According to their statements, the residents' bathrooms are fully operational. S1 confirmed that the public restrooms had indeed experienced a temporary issue and are currently undergoing repairs. Specifically, four of the restroom toilets were out of service for a period of four to five days, and not out of order for an entire month. The matter has been reported to Community Care Licensing as per protocol. S1 further mentioned that the facility is actively addressing plumbing problems with the public restrooms and working closely with a plumber to resolve the issue. During the visit, an inspection of the public restrooms was conducted. On the first floor, it was observed that two of the public restrooms were temporarily out of service. However, the restrooms on the second floor were found to be in full operational condition. Additionally, a tour of the residents' bathrooms was conducted, where it was noted that the toilets were flushing properly and the bathrooms were in good operational condition.

Investigation revealed the following: Staff 1 (S1), and residents R1-R10 (R1-R10) were interviewed and stated residents' bathrooms are operable and are in good working conditions. According to S1, two of the public restrooms on the first and second floors were out of service for a period of four to five days due to issues caused by tree roots. The facility is actively collaborating with a plumber to rectify pipe-related problems. S1 has confirmed that all resident bathroom toilets are fully operational and in good working condition. S1 stated in the event that a resident is unable to reach their room and needs access to a restroom, the facility has operational restrooms available in the bungalow located close to the lobby. R1-R10 stated they weren't aware the public restrooms weren't working. R1-R10 have expressed that they have not needed to utilize the public restrooms on the first and second floors, as they are equipped with their own private bathrooms within their respective bedrooms. R1-R10 stated staff is providing care and supervision and their daily needs are being met. R1-R10 stated that they were happy living at the facility. S1 agreed to the allegation that the public restrooms were non-operational.
Based on LPA’s observations, interviews that were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D.
Appeal rights were discussed, and copies of LIC9099, LIC9099-C, and LIC9099-D was provided to the
Health Wellness Director Wilford (Willie) Guerrero. Exit interview conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230522120849

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/30/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/07/2023 Section Cited CCR 87307(d)(2)	1 2 3 4 5 6 7	87307 (d) (2) Personal Accommodations and Services The premises shall be maintained in a state of good repair and shall provide a safe and healthful environment.	1 2 3 4 5 6 7	The licensee needs to repair two of the toilets in the public restroom on the first floor. The public restroom toilets should be in operational condition and in good repair at all times for the safety and well-being of residents, employees, and visitors. By or before the POC due date of 06/07/2023
	8 9 10 11 12 13 14	LPA Bunker observed the first-floor public restrooms and two of the toilets were non-operational. Notice posted on both restrooms doors out of service. This violation poses a potential health risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2023

LIC9099 (FAS) - (06/04)

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