198601566-11-27-2023-11-AS-MVAO-CZCTSM-20240110135923

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 11/27/2023
Date Signed: 11/27/2023 03:59:33 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
11/21/2023 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 11-AS-20231121125759

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: 80	DATE:	11/27/2023
		UNANNOUNCED	TIME BEGAN:	08:42 AM
MET WITH:	Lewis Ernest D.		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is not following infection control protocols.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 11/27/2023, Licensing Program Analyst (LPA) Antonine Richard conducted a 10-day complaint visit at this facility. LPA Richard conducted a risk assessment with Zoila Marroquin. The facility is free of Covid-19 infection. LPA met with Community Relations Director Rhonda Madrid S2. Administrator Lewis Ernest (S1) arrived shortly after and assisted LPA with the visit. LPA explained the purpose of the visit.

The investigation consisted of the following: On 11/27/2023, LPA Antonine Richard toured the facility with Comunity Relations director Rhonda Madrid S2. LPA observed six (6) staff and six (6) residents during the visit. LPA reviewed records for staff and residents. LPA interviewed six (6) staff (S1-S6) and 6 residents (R1- R6). LPA Richard interviewed six (6) out of Thirty four (34) staff members, and inspection of apartments #131, #138, #157, #205, #213, #214, #227, #252, #241, Lounge, Screening, Dining, and A review of staff and resident rosters was conducted.

REPORT CONTINUED IN LIC 9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

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 2

Control Number 11-AS-20231121125759

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: STUDIO ROYALE	FACILITY NUMBER: 198601566
	VISIT DATE: 11/27/2023

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Investigations revealed:

Allegation: Facility is not following infection control protocols.

It is alleged that the reporting party stated facility is not following infection control protocols. During an unannounced facility visit, LPA Richard interviewed six (6) staff and six (6) residents Based on the department’s interview with the Administrator and staff (S1-S6) all denied the allegation. LPA interviewed three (3) full time caregivers (S3, S4 and S5) who provide direct care to residents stated wearing a mask while around with residents inside the resident’s room is a must, especially if the resident tested positive for Covid-19 in the last two weeks. The administrator stated we are following Covid-19 protocols. We care about our residents well being. We always tell our staff to check if a resident feels sick to assist them.

LPA Interview with residents (R1-R6), all residents denied the allegation facility is not following infection control protocols. Residents stated that the staff always wearing masks when they enter their room. LPA observed S4 and S5 were wearing masks while working inside the resident room. Based on observation, interviews and record reviews, there is not sufficient of evidence to corroborate the above allegation.

Based on interviews, and observation the Department did not find sufficient evidence to support allegation Although the allegation may have happened or are valid, there is not a preponderance of evidence the alleged allegation did or did not occur, therefore the above allegation facility is not following infection control protocols is found to be Unsubstantiated

Exit interview was conducted A hard copy of the report was provided to administrator Lewis Ernest.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Antonine Richard	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 11/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/27/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2