198601566-1-6-2024-11-AS-MVAO-CZEURC-20240112144829

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 01/06/2024
Date Signed: 01/06/2024 01:12:38 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
11/28/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231128151552

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: 87	DATE:	01/06/2024
		UNANNOUNCED	TIME BEGAN:	11:45 AM
MET WITH:	Danilo Aguilan		TIME COMPLETED:	01:11 PM

ALLEGATION(S):

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Staff do not respond to resident requests for assistance in a timely manner.

INVESTIGATION FINDINGS:

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On 01/06/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent complaint visit to this facility. LPA was greeted by the Resident LIfestyle Director Danilo Aguilan. LPA contacted executive director EJ Lewis by telephone and explained the purpose of the visit is to deliver findings for the allegation mentioned above.

The investigation consisted of the following: A review of the facility's roster for residents and staff. Interviews with residents #1-#10 (R1-R10), staff #1-#4. A review of resident #1 (R1's) service records. and resident Monitoring Shift Logs and other pertinent records associated with this complaint was conducted. A tour of the facility was performed on 11/30/23.

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2024

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-20231128151552

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: 01/06/2024

NARRATIVE

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On 12/11/23 between 12:13 pm and 2:30 pm (4) out of (7) staff #5 - #11 care staff for (R1) denied the allegation. (S5-S8) did not acknowledge the incident involving (R1) and denied having a resident not assisted for over an hour. (S5-S8) stated not having any issues with (R1) and is being assisted accordingly every two hours or as needed. (S5-S8) verified the staff maintained a daily monitoring log for residents requiring assistance. (S5-S8) reported when the call button is activated the residents are assisted timely within minutes and not an hour. (S5-S8) does not recall (R1) having a fall incident in November 2023. (S9-S11) were not available for an interview on 11/30/23 and 12/11/23.

On 11/30/23 through 01/06/24, the Department reviewed monitoring logs for each shift for the month of November 2023 and it revealed that (R1) was being monitored and assisted with (ADL) every two hours. (R1) did not have any family representatives as listed to be contacted for statements.

Based on the information gathered, there is not enough evidence to corroborate the allegation.

Based on the information provider, an inspection of the facility, observation, interviews, and analysis of records, the Department found no evidence to support the allegation mentioned above.

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, as a result, the allegation is Unsubstantiated.

No deficiencies were identified during this visit.

An exit interview was conducted with Danilo Aguilan, and a copy of the report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20231128151552

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: 01/06/2024

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #3: Staff do not respond to resident requests for assistance in a timely manner.

The details of the complaint alleged the staff does not respond to residents for assistance on time. The complainant specifically referred to resident #1 (R1) who had fallen off the bed and was on the ground floor after activating the call button for assistance. The complainant reported staff did not assist (R1) for over an hour. The complainant was not forthcoming with further details on the incident with the date, time, or the staff members involved.

On 11/30/23 between 11:30 am and 12:45 pm (9) out of (10) residents #2- #10 (R2-R10) stated they were assisted in a timely manner. Nine out of ten residents stated they have had no issues or concerns with incontinent care and in some cases do not require assistance with daily activities.

An interview with (R1) recalled an incident when no staff member was available to assist after activating the call button in the bathroom for over an hour and sitting in the toilet during that time. (R1) could not recall the date, the time, and the two staff members’ names that were involved. (R1) stated it was an isolated incident and it may have been a week or two ago, otherwise, the staff does respond timely when called within (5) to 10 minutes. (R1) claimed not to have had a fall incident recently or in the past. The Department tested (R1’s) call button on 11/30/23 and observed the equipment to be operable.

On 11/30/23 between 10:20 am and 11:20 am (2) out of (2) staff #1 and #4 (S1 and S4) stated residents are monitored every two hours for each shift or as needed when the call button is activated. (S1 and S4) stated for every shift the residents that require assistance and are not independent are being monitored every two hours during each shift and the facility maintains a daily monitoring log for each resident for each shift. (S1 and S4) did not acknowledge the incident involving (R1) and denied having a resident not assisted for over an hour. (S1 and S4) reported even in the busiest time, a resident is assisted within 10 minutes. The front desk is alerted when a resident activates the call button and alerts the front desk to dispatch a care staff immediately. (S1 and S4) does not recall (R1) having a fall incident in November 2023.

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 01/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2024

LIC9099 (FAS) - (06/04)

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