198601566-11-15-2024-11-AS-JHAD-DBA3NH-20241122172356

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 11/15/2024
Date Signed: 11/15/2024 05:49:42 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/08/2024 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20241108163340

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: 95222	DATE:	11/15/2024
		UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Tamera Gant		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Facility failed to ensure staff were adequately trained in emergency evacuation.

INVESTIGATION FINDINGS:

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On 11/15/24, California Department of Social Services/Community Care Licensing (CDSS/CCL) associate conducted an initial unannounced complaint visit. (CDSS/CCL) associate was greeted by Wellness Director Tamera Gant. (CDSS/CCL) associate explained the purpose of this visit was to investigate the allegation mentioned above.

The investigation consisted of the following: A tour of the physical plant, interviews, and collection of records. Interviews with staff #1-#3 (S1-S3) and residents #1-#9 (R1-R4). A review of Personnel Report LIC 500 dated: 0516/24), Faciltiy Roster (dated: 10/05/24), Staff Schedule, Emergency Disaster Plan for Residential Care Facilities LIC 610E (dated: 05/15/24), Fire Drill Report (dated: 06/17/24, 06/18/24, & 08/27/24) Disaster and Emergency Manual (dated: 03/01/22), and Fire & Evacuation Plan (dated: 09/12/24)

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024

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-20241108163340

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: STUDIO ROYALE	FACILITY NUMBER: 198601566
	VISIT DATE: 11/15/2024

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Facility failed to ensure staff were adequately trained in emergency evacuation.

The details of the complaint alleged the facility staff are not adequately trained in the event of emergency evacuation. It is reported on 11/7/24 at approximately 5:00 pm, the facility staff were uninformed on how to handle Emergency Evacuation when the fire alarm went off. There was no facility staff to assist residents with mobility who were deemed non-ambulatory by their medical doctor and were unable to safely descend from the stairwells timely. Although it was determined it was a false alarm, there would not have been trained staff to help the residents who needed assistance on the second floor.

On 11/15/24, between 09:30 am - 03:10 pm, the Department interviewed (3) out of (3) staff who claimed this allegation was false. Staff #1 (S1) stated that care partner staff are trained in Disaster and Emergency Procedures. (S1) expressed that on 11/7/24 the facility fire alarm was set off by a resident. (S1) stated there was no fire and it was a false alarm. (S1) said they had to dispatch the local Fire Department to turn off the alarm and that process took about 15 minutes to complete. (S1) reported that there is no shortage of care partner staff to work on each shift. The AM and PM shifts had four (4) to five (5) staff, while the overnight shift had three (3) or four (4) overseeing both floors. The non-care provider staff are also cross-trained as care providers in the event of a staffing crisis. (S1) stated that the second-floor stairs are equipped with Emergency Evacuation Chairs. (S2-S3) confirmed working on 11/07/24 and assisted with notifying or escorting residents to safety.

On 11/15/24, between 11:00 am - 12:30 pm, the Department interviewed (8) out of (9) residents were unable to corroborate this accusation. Three (3) out of nine (9) noted that staff participated and collaborated with the management staff to assist in guiding directions for residents to safety. Five (5) out of nine (9) residents claimed they were informed in person that it was a false alarm. Eight (8) out of (9) expressed that they had no concern for their safety living at this facility. Resident #9 (R9) refused to participate in an interview. Residents #1-#9 (R1-R9) are all residents residing on the second floor of this facility.

As a result of the Department reviewing the facility's Personnel Report LIC 500 (dated: 05/16/24), Facility Roster (dated: 10/05/24), Staff Schedule (dated: 11/4/24-11/10/24), Emergency Disaster Plan for Residential Care Facilities LIC 610E (dated: 05/15/24), Fire Drill Report (dated: 06/17/24, 06/18/24, & 08/27/24), (Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20241108163340

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: STUDIO ROYALE	FACILITY NUMBER: 198601566
	VISIT DATE: 11/15/2024

NARRATIVE

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Disaster and Emergency Manual (dated: 03/01/22), and Fire & Evacuation Plan, revealed sufficient staffing on each shift and that staff have completed training on emergency and disaster preparedness and procedures. The Department observed three (3) Emergency Evacuated Chairs. Based on the information gathered, there is no sufficient evidence to support the allegation mentioned in this complaint.

Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview is conducted with Wellness Director Tamera Gant, and a copy of the report is provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 11/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/15/2024

LIC9099 (FAS) - (06/04)

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