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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601566
Report Date: 11/02/2023
Date Signed: 11/02/2023 05:07:38 PM


Document Has Been Signed on 11/02/2023 05:07 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:LEWIS,ERNEST D.FACILITY TYPE:
740
ADDRESS:3975 OVERLAND AVENUETELEPHONE:
(310) 836-5854
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:175CENSUS: 89DATE:
11/02/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:54 PM
MET WITH:Danilo Aguilan, Resident Lifestyle DirectorTIME COMPLETED:
05:00 PM
NARRATIVE
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On 11/02/2023 at 8:07 am Licensing Program Analyst (LPA) David España conducted an initiated a 10-day complaint investigation subsequent visit (11-AS-20231025142545). Upon arriving at the facility, LPA met with S#2 who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct inspections.

LPA along with S#2 observed First floor bathroom #1 and #2 and Second Floor Bathroom #3 and #4. S#2 stated that First floor bathroom #1 and #2 and Second Floor Bathroom #3- and #4-bathroom ceiling fan/vent were working. LPA disagreed with statement and found that First-floor bathroom #1 and #2 and Second Floor Bathroom #3- and #4-bathroom ceiling fan/vent were not working. LPA observed movable bins used for storing or transporting solid wastes do not have tight-fitting covers on the containers; or in good repair. Therefore, based on LPA interviews, and observation and the LPA’s findings the facility was cited on 11/02/2023.

According to the California Code of Regulations, Title 22, the following deficiency were cited:

  • 87303(a) Maintenance and Operation
  • 87303(f)(4) Maintenance and Operation

See LIC 809-D for citation. Appeal Rights Discussed/An exit Interview was conducted. Report was issued.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 11/02/2023 05:07 PM - It Cannot Be Edited

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

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/02/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/17/2023
Section Cited
CCR
87303(a)

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(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
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Licensee will take swift action having a safe and good repair facility, reducing the potential risk to the resident in care. The licensee stated all bathroom will be safe and good repair for residents, staff, and visitors moving forward email david.espana@dss.ca.gov.
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Based on observation and interview S#2 did safe and good repair facility, making it accessible to all residents which poses an immediate health, safety, and personal rights risks to persons in care.
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Type B
11/17/2023
Section Cited
CCR87303(f)(4)

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(f)(4) Movable bins when used for storing or transporting solid wastes from the premises shall have tight-fitting covers on the containers; shall be in good repair; and shall be rodent-proof unless stored in a room or screened enclosure.
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Licensee will take swift action having a safe and good repair facility, reducing the potential risk to the resident in care. The licensee stated all bins will be safe and good repair for residents, staff, and visitors moving forward email david.espana@dss.ca.gov.
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Based on observation and interview S#2 did safe and good repair facility, making it accessible to all residents which poses an immediate health, safety, and personal rights risks to persons in care.
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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: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:
DATE: 11/02/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/02/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2