198601566-10-6-2023-11-AS-UCOL-CWKUPS-20231013154602

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 10/06/2023
Date Signed: 10/06/2023 02:07:13 PM

Unsubstantiated

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
11/03/2022 and conducted by Evaluator David Espana

COMPLAINT CONTROL NUMBER: 11-AS-20221103104439

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:	10/06/2023
		UNANNOUNCED	TIME BEGAN:	12:31 PM
MET WITH:	Ernest "EJ" Lewis, Administrator		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff do not ensure incontinent residents are cleaned properly.
Facility staff transfer residents in a rough manor.

INVESTIGATION FINDINGS:

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**This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 11/07/2022.**

On 10/06/2023 at 12:31 pm Licensing Program Analyst (LPA) David España conducted a subsequent complaint investigation at the above facility to address the following allegations. LPA met with Administrator, Ernest “EJ” Lewis and explained the purpose of this visit was to deliver findings for this complaint. Upon arrival at the facility, LPA España conducted a risk assessment at the facility entrance. Based on the assessment, the facility is clear of Covid-19 infection. At approximately 10:55am LPA conducted a tour of the facility. During the course of the investigation at approximately 11:25am LPA spoke with five (05) staff members. Between 12:35pm – 1:45pm LPA interviewed ten (10) out of ninety-seven (97) residents. In addition, LPA Alvizar spoke with the witnesses that have pertinent information about the allegation.
See LIC 9099-C on the next page

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

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-20221103104439

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: 10/06/2023

NARRATIVE

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Allegation #1: Facility staff do not ensure incontinent residents are cleaned properly.
It was alleged that caregivers always rush when they clean up incontinent resident(s). Staff revealed that they always clean incontinent residents properly and on time. Nine (09) out of ten (10) residents indicated that they had no concerns regarding their incontinent care. Residents stated that the staff helps them and cleans them as needed. Based on inspection, observation, and interviews there is no sufficient information to verify the allegation. Therefore, the allegation is deemed unsubstantiated at this time.

Allegation #2 Facility staff transfer residents in a rough manor.
It was alleged that the staff cleaning resident #1 (R1) is not able to provide transfer assistance.
Staff interviews revealed that R1 requires two (02) party assistance. All staff are trained to provide two (02) person assistance for the residents, as required. Nine (09) out of ten (10) Residents interviewed during investigation had no concerns regarding their transfer assistance.

A review of facility records verified the information received from facility staff. Based on observation, interviews, available gathered from the records, there was no sufficient information and/or evidence to support the allegations. Therefore, the allegation is deemed unsubstantiated.

No deficiencies were cited during this visit. Exit interview was conducted and a copy of report was issued to the Administrator, Ernest “EJ” Lewis.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221103104439

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: 10/06/2023

NARRATIVE

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Allegation #1: Facility staff do not ensure incontinent residents are cleaned properly.
It was alleged that caregivers always rush when they clean up incontinent resident(s). Staff revealed that they always clean incontinent residents properly and on time. Nine (09) out of ten (10) residents indicated that they had no concerns regarding their incontinent care. Residents stated that the staff helps them and cleans them as needed. Based on inspection, observation, and interviews there is no sufficient information to verify the allegation. Therefore, the allegation is deemed unsubstantiated at this time.

Allegation #2 Facility staff transfer residents in a rough manor.
It was alleged that the staff cleaning resident #1 (R1) is not able to provide transfer assistance.
Staff interviews revealed that R1 requires two (02) party assistance. All staff are trained to provide two (02) person assistance for the residents, as required. Nine (09) out of ten (10) Residents interviewed during investigation had no concerns regarding their transfer assistance.

A review of facility records verified the information received from facility staff. Based on observation, interviews, available gathered from the records, there was no sufficient information and/or evidence to support the allegations. Therefore, the allegation is deemed unsubstantiated.

No deficiencies were cited during this visit.
Exit interview was conducted and a copy of repot was issued to the Administrator, Ernest “EJ” Lewis.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2023

LIC9099 (FAS) - (06/04)

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