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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 01/04/2024
Date Signed: 01/05/2024 11:10:40 AM

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
12/26/2023 and conducted by Evaluator Pamela Bunker
COMPLAINT CONTROL NUMBER: 11-AS-20231226112219
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: 86DATE:
01/04/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ernest LewisTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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9
Staff did not ensure resident's bandages were being changed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Thursday, January 04, 2024, Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Executive Director Ernest Lewis. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: Interviews with staff members 1-2 (S1-S2) and residents 1-8 (R1-R8). According to the statements from S1-S2, there were no instances where staff did not ensure resident's bandages were not being changed. LPA Bunker thoroughly reviewed R1's records and requested copies of relevant supporting documents for a detailed analysis. It was clarified by S1-S2 that the decision to change the resident's bandage indicated that the facility had no direct control over the wound. S1-S2 stated the facility is providing supporting care and supervision needed to meet the needs of the resident receiving home health care. S1-S2 stated Resident 1 is receiving care for the pressure injury from the physician and appropriate skilled professional. See continued LIC9099-C page 2
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
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-20231226112219
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: 01/04/2024
NARRATIVE
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Continued LIC812-C page 2

Allegation: Staff did not ensure resident's bandages were being changed. In response to this, allegation interviews were conducted with both staff members 1-2 (S1-S2) and residents 2-8 (R2-R8). The collective feedback from these interviews unanimously indicated no issues concerning bandages not being changed. Resident 1 (R1) stated the issue with changing the bandage on the left leg was resolved. S1 stated if a resident has a stage one or two pressure injury condition it is diagnosed by a physician or an appropriately skilled professional. S1-S2 stated all aspects of care performed by the medical professional and facility staff are documented in the resident's file. Residents 1-8 (R1-R8) expressed their satisfaction with living at the facility, highlighting the respect, dignity, and quality of care they receive. They also commended the facility for providing a secure, healthful, and comfortable living environment and they were happy. S1-S2 refuted the allegation, reinforcing the commitment to safety and well-being upheld at the facility.

Investigation revealed the following: During interviews, staff members S1-S2 they emphasized that the wound care needs of resident 1 are being meticulously addressed by a UCLA wound care clinic. They elaborated that for certain residents, Home Health Agencies are engaged to administer bandage changes and specialized dressing services on-site. It was categorically stated by S1-S2 that the facility’s nurse is not involved in direct wound care services but plays a supportive role. S1-S2 and the facility nurse have conducted thorough briefings with all residents regarding the wound care procedures. Addressing specific concerns, S1-S2 assured that no resident is expected to self-administer wound care. They emphasized the facility’s commitment to providing essential support and supervision, particularly for residents receiving home health care services. For residents with stage one or two pressure injuries, diagnosis, and care are exclusively managed by physicians or qualified professionals, with all care procedures meticulously documented in the resident's files. Residents R1-R8 have affirmed the adequacy of care and supervision provided by the staff. S1-S2 reiterated their comprehensive understanding and adherence to Title 22 Regulations regarding wound care procedures, firmly denying any allegations suggesting non-compliance or negligence. This collective testimony from S1-S2 and R2-R8 robustly refutes the allegation in question.
Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated. A copy of the Complaint Investigation Report LIC9099, and LIC9099-C, was provided to the Administrator. There were no deficiencies cited. Exit interview conducted.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2