198601566-12-20-2023-11-AS-MVAO-CZKRB8-20240117115215

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 12/20/2023
Date Signed: 12/20/2023 02:04:09 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
12/15/2023 and conducted by Evaluator Alfonso Iniguez

COMPLAINT CONTROL NUMBER: 11-AS-20231215133906

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: 92	DATE:	12/20/2023
		UNANNOUNCED	TIME BEGAN:	09:11 AM
MET WITH:	Ernesto Lewis-Executive Director		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not respond to resident’s call in a timely manner.
Staff does not ensure water temperature was appropriate for residents
Facility dishwasher is in disrepair.

INVESTIGATION FINDINGS:

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

On 12/20/2023 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Ernesto Lewis/Administrator. LPA explained the purpose of this visit.

Investigation Consited on the following: Administrator’s Interview (A#1), Resident interviews (R#1-R#9), Staff interviews (S#1-S#9), a tour of the facility including 10 residents’ rooms bathrooms and kitchen. LPA obtained and reviewed the following documents: Resident’s Roster, Personnel Roster, (R#1-R#9) Identification and Emergency Information, (R#1-R#9) Admissions agreements, (R#1-R#9) Physicians Report for Residential Care Facilities for the Elderly, (R#1-R#9) Needs and Services Plan, (R#1-R#9) Medication Administration Record (MAR) for the month of December 2023 and copies of facility water temperature log.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

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 4

Control Number 11-AS-20231215133906

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: 12/20/2023

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

Allegation: Staff did not respond to residents’ call in a timely manner.

The details of the complaint alleged that facility staff are not responding in a timely manner to residents’ emergency calls.

During an interview with the Administrator (A#1), he stated that an alarm signal goes to the call light panel when a resident pulls the cord from the bedroom. We have one in the receptionist area and one in the medication area. So, when the person sees the alarm on the system, they alert the care staff by walkie-talkie. In addition, (A#1) stated that attending the resident's call takes approximately 5 to 10 minutes.

During interviews with residents (R#1-R#9), (2) out of (9) stated that they have never used the signal cord, but they think their staff will come immediately to assist them. Also, (5) out of (9) residents stated that they had used the cord, and most directly, the staff came and assisted them. Two (2) of the nine (9) residents have never used the emergency pull cord before. On the other hand, (1) out of (9) residents stated that it took the staff almost one hour to assist them.

During interviews with staff (S#1-S#9), (9) out (9) stated that the facility's protocol when it comes to the residents using the signal system is the following:

When the resident pulls the cord, it sends an alert to the front, where it shows on a monitor where it is coming. The receptionist sees the alert on it. She alerts the care staff that the resident needs assistance immediately.

In addition, (8) out of (9) staff stated that it takes approximately 10 minutes to tend to the residents' calls and never an hour. On the other hand, (1) out of (9) staff stated that one time they heard that it took the staff one hour to tend to a resident's pull cord.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20231215133906

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: 12/20/2023

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

Allegation: Staff do not ensure the water temperature was appropriate for residents.

The details of the complaint alleged that the water temperature is not appropriate for residents.

During the review of the records, LPA observed the facility’s temperature log from January to December 2023. LPA observed that (7) residents’ rooms were chosen, and the maintenance person recorded the water temperature. The water temperature is between 105F°-120 F°. The water temperature never reached below 105 F°. or above 120 F°.
During the facility tour, LPA Iniguez visited 9 residents’ bathrooms (127, 129, 134, 139, 142, 114, 259, 258, and 250). LPA measured the water temperature with his thermometer and observed that the temperature was between 105F°. to 120F°. It never reached below 105 F°. or above 120 F°. In addition, LPA observed the water pressure to be enough for the residents to use.
During an Interview with the Administrator (A#1), he stated that there is hot water in the residents’ bathrooms and enough water pressure.
During interviews with residents (R#1-R#9), (8) out of (9) stated that they had hot water in their bathrooms and the water pressure was good. On the other hand, (1) out of (9) residents stated that they lived in a shared room, but only two used the bathroom.
During interviews with staff (S#1-S#9), (9) out (9) stated that the only ones sharing bathrooms are the shared rooms which are (6). In addition, (9) out of (9) said that there is hot water in the residents’ bathrooms and enough water pressure.

Allegation: Facility dishwasher is in disrepair.

The details of the complaint alleged that the facility dishwasher is in disrepair.

During a facility tour, LPA Iniguez inspected the kitchen’s dishwasher. LPA asked one of the kitchen staff to start the dishwasher, and he observed that the machine was working correctly.
During an Interview with the Administrator (A#1), he stated that the facility dishwasher is working correctly.
During an Interview with (S#1), she stated that the facility’s dishwasher works appropriately.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20231215133906

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: 12/20/2023

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

During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated.

California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted, and a copy of the Complaint Report was given to Ernesto Lewis /Administrator.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2023

LIC9099 (FAS) - (06/04)

Page: 4 of 4