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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 01/21/2025
Date Signed: 01/21/2025 04:43:54 PM

Substantiated


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
04/04/2024 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240404155510
FACILITY NAME:STUDIO ROYALEFACILITY NUMBER:
198601566
ADMINISTRATOR:LEWIS,ERNEST D.FACILITY TYPE:
740
ADDRESS:3975 OVERLAND AVENUETELEPHONE:
(310) 836-5854
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:175CENSUS: 92DATE:
01/21/2025
UNANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH:William Boles Jr. TIME COMPLETED:
03:59 PM
ALLEGATION(S):
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Staff did not provide a lawful eviction notice to resident in care.
INVESTIGATION FINDINGS:
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On January 21,2025, an associate from the California Department of Social Services/Community Care Licensing (CDSS/CCL) conducted a subsequent, unannounced complaint visit. The Executive Director, William Boles, greeted the associate. The associate explained that the purpose of this visit was to investigate the allegation mentioned above.

The investigation included a tour of the facility, interviews, and the collection of records. Interviews were conducted with staff members #1, #2 and #3 (S1-S3). The associate reviewed several documents, including the Personnel Report LIC 500 (dated 05/16/24), the Facility Roster (dated 10/05/24), the 30-Day to Terminate Tenancy Notice (dated 03/05/24), and other pertinent records associated with this complaint.

(Evaluation Report continues LIC 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025
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-20240404155510
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: 01/21/2025
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff did not provide a lawful eviction notice to resident in care.

The complaint asserted that the facility issued an unlawful eviction notice to Resident #1 (R1). The complaint specified that management had reached a final decision to cease collaboration with (R1) and was no longer willing to accept further payments for services. It was reported that (R1) received a 30-Day Eviction Notice that did not adhere to the requirements set forth by the California State Department of Social Services Community Care Licensing (CDSS/CCL) Title 22 Regulations.

On April 9, 2024, between 9:00 AM and 3:00 PM, the Department conducted interviews with two staff members, designated as Staff #1 and Staff #2, concerning the allegation that (R1) had failed to comply with the facility's general policies. Staff #1 indicated that (R1) exhibited behaviors that were prohibited and adversely affected other residents and the community. Additionally, according to Staff #2, (R1) is an accumulator who collects unsanitary items, which are subsequently brought back to the room. Staff #1 maintained that the eviction notice issued to (R1) was compliant with Title 22 Regulations, stating that such action was necessitated by (R1's) inappropriate behaviors and the impact on the health and safety of other residents.

On January 17, 2025, between 1:30 PM and 3:30 PM, the Department interviewed a staff member identified as Staff #3 regarding this allegation. Staff #3 reported that (R1) was relocated from the facility on April 5, 2024, with assistance from the placement agency Brightside Referrals, and is currently no longer residing at Studio Royale. Staff #3 also noted that the eviction notice and (R1's) departure from the facility occurred prior to (S3's) employment with Studio Royale.

An additional interview with Staff #1 was not feasible, as (S1) is no longer employed with Studio Royale and no forwarding contact information was provided. The Department was likewise unable to interview Resident #1 (R1) due to the absence of forwarding contact information.

The Department's review of service files and the 30-Day Notice to Terminate Tenancy (dated 03/05/24) revealed that management issued an invalid eviction notice, failing to comply with (CDSS/CCL) Title 22 Regulations concerning eviction procedures.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20240404155510
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: 01/21/2025
NARRATIVE
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The eviction notice was found to be incomplete, lacking several critical pieces of information, resources available to assist with alternative housing and care options, referral services for alternative housing, and confirmation that a written eviction notice should be submitted to the licensing agency within five days.

The Department concluded that there is sufficient evidence to substantiate the allegation based on information gathered from facility inspections, observations, interviews, and records analysis. Consequently, the allegation regarding the violation of personal rights, specifically that "Staff did not provide a lawful eviction notice to a resident in care," has been deemed substantiated.

An exit interview was conducted with William Boles, during which copies of the reports were distributed along with appeal rights.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20240404155510
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/04/2025
Section Cited
CCR
87224(B)(1-2)(f)
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87224(B) Resources available to assist in identifying alternative housing and care options... 1. Referral services that will aid in finding alternative housing. 2. Case management... help manage individual care and service needs. (f) A written report of any eviction shall be sent to the licensing agency within five (5) days.
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The licensee agrees to submit a Plan of Correction (POC) to the California Community Care Licensing Division (CCLD) by 02/04/25. The licensee will review Title 22 87244 regarding Eviction Procedures and provide a written statement confirming that the review has been completed and will comply with this regulation. The POC should be sent to LPA Dabuet at ernand.dabuet@dss.ca.gov by the specified date.
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This requirement was not met as evidence by:
Based on interviews and record reviews, the Licensee failed to issue a valid eviction notice in compliance with Title 22 Regulations. This violation poses a potential health and safety risk to residents in care.
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Type B
02/04/2025
Section Cited
CCR
87211(a)(D)
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87211-(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(D) Any incident which threatens the welfare, safety or health of any resident...abuse of a resident by staff or other residents, or unexplained absence of any resident.
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The licensee agrees to submit a Plan of Correction (POC) to the California Community Care Licensing Division (CCLD) by 02/04/25. The licensee will review Title 22 87211 regarding Reporting Requirements and will comply with this regulation. The POC should be sent to LPA Dabuet at ernand.dabuet@dss.ca.gov by the specified date.rovide a written statement confirming that the review has been completed and
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This requirement was not met as evidence by:
Based on interviews and record reviews, the Licensee failed to report incidents involving (R1's) health and safety welfare. This violation poses a potentinal health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20240404155510
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/21/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/04/2025
Section Cited
CCR
87405(b)(2)
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87405(b)(2) Administrator-Qualifications and Duties. (b) The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations.
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The licensee/administrator will create a plan to ensure that the administrator performs knowledge of and conform to applicable laws, rules and regulations. A written statement from licensee that reviewed 87405 POC will be sent to LPA Dabuet by 02/04/25 at ernand.dabuet@dss.ca.gov
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This requirement was not met as evidenced by:
Based on interview and record reviews the administrator failed to adhere to Title 22 regulations, resulting to multiple citations. This violation poses a potential health and safety to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5