198601566-11-2-2023-11-AS-UCOL-CYF349-20231211165445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 11/02/2023
Date Signed: 11/02/2023 05:06:45 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
10/25/2023 and conducted by Evaluator David Espana

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231025142545

FACILITY NAME:	STUDIO ROYALE		FACILITY NUMBER:	198601566
ADMINISTRATOR:	LEWIS,ERNEST D.		FACILITY TYPE:	740
ADDRESS:	3975 OVERLAND AVENUE		TELEPHONE:	(310) 836-5854
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY:	175	CENSUS: 89	DATE:	11/02/2023
		UNANNOUNCED	TIME BEGAN:	08:23 AM
MET WITH:	Danilo Aguilan, Resident Lifestyle Director		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not address a change in resident's condition
Staff did not ensure the resident was adequately fed
Staff did not keep the resident's room clean & sanitary
Staff left resident soiled in urine for an extended period of time
Staff left resident's mattress on the floor
Staff did not keep the facility free of flies

INVESTIGATION FINDINGS:

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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 for the allegation listed above. 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.

The investigation consisted of the following: On 11/02/2023 at 8:19 am LPA España conducted a tour of facility plant; reviewed records for staff and residents and observations. LPA España conducted interviews with Ten (10) out of Eighty-nine (89) residents. LPA España interviewed Eight (8) out of Fifty-one (51) staff members. LPA España interviewed with two (2) out of 2 Witnesses.

Contunied 9099-C

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: 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.

LIC9099 (FAS) - (06/04)

Page: 1 of 5

Control Number 11-AS-20231025142545

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: 11/02/2023

NARRATIVE

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Allegation: Staff did not address a change in resident's condition.

The investigation revealed, per LPA España interviews, record reviews, and observations, with Ten (10) out of Eighty-nine (89) residents interviewed from Studio Royale, that the facility resident family members/responsible parties are notified of any changes to a resident’s health condition. S#1-S#10, informed the LPA that all changes to a resident’s health are documented in their resident file. S#1-S#10 also stated that S#1 makes sure that family members are notified, and the facility makes arrangement for medical appointments.

In addition, S#1 and S#2 inform families of resident incidents that occur inside and outside of the facility. LPA observed based on interviews with S#1-S#10 that there has never been an issue with a resident’s family member not being notified of changes to a resident’s condition. S1 informed the LPA that R#4’s W#1 was notified of change of medical condition because of event on 10/16/23; 10/19/23; 10/07/23; 10/26/23; 10/19/23; 10/26/23; 10/27/23; 10/31/23; 10/19/23; via email.

S#1 stated that the facility contacted R#4’s W1 and informed of R#4’s medical condition. R#4’s W1 did not inform that there were any concerns with R#4’s medical condition and what was noted is that W1 agreed to the conditions of R#4 having issues at the facility. In addition, the LPA interviewed Eight (8) out of Fifty-one (51) staff members who stated staff always documents and informs the resident’s family or responsible part of health care condition, or treatment.

LPA interviewed two (2) out of 2 Witness and Witness #1 (W#1) stated staff always documents and informs the resident’s family or responsible part of health care condition, or treatment. LPA interviewed Witness #2 who disagreed with the level of care that was being provided to R#4. The LPA also interviewed Ten (10) out of Eighty-nine (89) residents who informed the LPA that the facility assists them with medical concerns and inform their family of any medical updates.

Based on information gathered, LPA did not find sufficient evidence to support allegation: Staff did not address a change in resident's condition.

Continued on 9099-C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (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

LIC9099 (FAS) - (06/04)

Page: 2 of 5

Control Number 11-AS-20231025142545

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: 11/02/2023

NARRATIVE

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Allegation: Staff did not ensure the resident was adequately fed.

LPA España interviewed Eight (8) out of Fifty-one (51) staff members who stated incontinent residents are checked during those periods of time when they are known to be incontinent and tray services are provided. LPA interviewed Eight (8) out of Fifty-one (51) staff members stated that incontinent residents are kept clean and dry, and that the facility remains free of odors from incontinence, and all are fed. LPA España interviewed Eight (8) out of Fifty-one (51) staff members and stated staff does receive ongoing training on managing residents' incontinence. LPA interviewed Eight (8) out of Fifty-one (51) staff members and stated residents are fed three meals a day plus snacks. LPA interviewed Ten (10) out of Eighty-nine (89) residents who stated residents are adequately fed and they are getting plenty of food to eat, three (3) meals per day plus snacks, breakfast, lunch, dinner, and snacks daily.

LPA interviewed Ten (10) out of Eighty-nine (89) residents who stated the facility serves a well-balanced meal.LPA interviewed Ten (10) out of Eighty-nine (89) residents who stated the facility also provides alternative options, if residents does not want what is on the menu.LPA interviewed Ten (10) out of Eighty-nine (89) residents who stated the portions of food served are more than enough and they get plenty of food to eat and the staff will give them seconds.

LPA interviewed Ten (10) out of Eighty-nine (89) residents who stated that they had no complaints about the food. All interviewed Ten (10) out of Eighty-nine (89) residents stated they are treated with dignity and respect, and the staff cares about them. LPA interviewed Ten (10) out of Eighty-nine (89) residents and stated that they are comfortable, the staff is providing the necessary care and supervision and their daily needs are being met.

LPA interviewed Ten (10) out of Eighty-nine (89) residents and stated they were happy at the facility and had no problems, issues, or concerns. LPA noted that Eight (8) out of Fifty-one (51) staff members and Ten (10) out of Eighty-nine (89) residents who denied the allegations.Based on information gathered, LPA did not find sufficient evidence to support allegation: Staff did not ensure the resident was adequately fed.

Continued on 9099-C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (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

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20231025142545

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: 11/02/2023

NARRATIVE

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Allegation: Staff did not keep the resident's room clean & sanitary.

LPA interviewed Ten (10) out of Eighty-nine (89) residents and inspected ten (10) resident rooms and found that all ten (10) bedrooms were found to be in clean and sanitary condition. LPA interviewed Ten (10) out of Eighty-nine (89) residents who did not have any concerns with the allegation listed above. Eight (8) out of Fifty-one (51) staff members interviewed stated that housekeeping cleans resident bedrooms on a weekly basis and caregivers clean resident bedrooms while providing care to residents. Based on information gathered, LPA did not find sufficient evidence to support allegation: Staff did not keep the resident's room clean & sanitary.

Allegation: Staff left resident soiled in urine for an extended period of time.

The complainant alleges resident #4 (R#4's) mattress was soiled in urine and staff failed to assist with incontinence care. An interview with Ten (10) out of Eighty-nine (89) residents stated that the staff does help daily with his incontinence care. An interview with W1 stated the staff did help daily with R#4 incontinence care. W1 reported that R#4 had issues with behaviors. LPA España noted in an interview via telephone with W1 R#4 would refuse services at Studio Royale. Due to R#4 behavior issues, it was noted that W1 stated R#4 maybe did not ask for help and maybe does not recall if R#4 was left for an extended period within soiled diapers or soiled mattresses. Interviews with witness #1 along with Ten (10) out of Eighty-nine (89) residents reported no resident has been left in soiled diapers or soiled mattresses for an extended period. LPA España interviewed Eight (8) out of Fifty-one (51) staff members who claimed these allegations were false and that (R#4) was assisted daily incontinence care. Furthermore, per interviews with Ten (10) out of Eighty-nine (89) residents states that they have not been left in soiled mattress for an extended period as this is not allowed according to the Administrator. Based on information gathered, LPA did not find sufficient evidence to support allegation: Staff left resident soiled in urine for an extended period of time.

Allegation: Staff left resident's mattress on the floor

LPA España interviewed Eight (8) out of Fifty-one (51) staff members and conducted file reviews and observed apartments (#) 136; 129; 213; 230; 150; 212; 215; 214; and 218 which showed that every day during the day and evening apartments are checked cleaned. LPA España interviewed Eight (8) out of Fifty-one (51) staff members interviewed and all deny the allegation. LPA España observed of R#4 status at facility is considered longer a resident of Studio Royale and apartment 212 is currently vacant as of 11/02/2023. Based on information gathered, LPA did not find sufficient evidence to support allegation: Staff left resident's mattress on the floor. Continued on 9099-C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (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

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20231025142545

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: 11/02/2023

NARRATIVE

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Allegation: Staff did not keep the facility free of flies.

LPA España toured the physical plant with S#2 at approximately 10:00 am - 1:45 pm., LPA observed apartments (#) 136; 129; 213; 230; 150; 212; 215; 214; and 218 which did not contain flies or odors in the room. LPA España did not observe flies in the hallway or kitchen. LPA España walked the grounds of the facility and noticed 8 wild cats. LPA España interviewed Eight (8) out of Fifty-one (51) staff members who stated there was no dogs located at the facility. LPA España determined that there are two (2) cats located in apartments #138 and #156. LPA España noted that the complainant stated flies’ present, however, unfounded claim.

During the inspection visit on 11/02/23, the Department did observe Dewey Pest Control company invoices which show services: 10/17/23; 09/19/23; 08/21/2023; 06/01/2023; 09/12/2023; and Pest Sighting Log “Pest Control” with dates of 06/06/23; 06/13/23; 06/20/23; 06/30/23; 07/16/23; 08/27/23; 09/29/23; 10/27/23 etc. LPA España on behalf of the Department (CCLD) conducted an inspection of the entire facility and did not observe ants, flies, cockroaches, or bed bugs. The Department found the facility to be safe and sanitary. LPA España interviewed Eight (8) out of Fifty-one (51) staff members who claimed this allegation to be false.

The facility has a contract with a reputable pest control company and has provided receipts to indicate that routine maintenance services are being performed. Ten (10) out of Eighty-nine (89) residents interviewed all verified that they (residents) have not encountered any pest activity at this facility and felt this is a safe and sanitary facility.

Based on information gathered, LPA did not find sufficient evidence to support allegation: Staff did not keep the facility free of flies.

At 4:45 pm exit interview conducted, and a copy of the report was provided to the facility.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (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

LIC9099 (FAS) - (06/04)

Page: 5 of 5