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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 03/27/2025
Date Signed: 03/27/2025 02:18:05 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
03/21/2025 and conducted by Evaluator Deborah Lee
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250321091156
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:
03/27/2025
UNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Tamara GantTIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Staff do not treat residents with respect
INVESTIGATION FINDINGS:
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On March 27, 2025 Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced complaint visit to address the allegation listed above. LPA was greeted by Tamara Gant, Wellness Director who granted access to the facility and the purpose of the visit was explained. Bill Boles, Executive Director subsequently arrive to speak with LPA.

The investigation consisted of the following:
On March 27, 2025, LPA and staff Lupe Delgado conducted a tour of facility, observations made, LPA reviewed and obtained copies of the following: client roster(dated 3/2/25 ), staff roster (dated 5/6/24 ), staff training certificates on resident's rights (various dates: 1/17/25, 2/27/25, 3/5/35, 3/15/25,3/18/25), Food Handlers certificates for all kitchen staff, Appraisal/Needs and Services plans for (R1) dated 4/11/24 ,Physicians report for (R1), dated 4/20/24 ; interviews were conducted with Facility Administrator, 6 staff, and 6 Residents
page 1 of 3
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
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 3
Control Number 11-AS-20250321091156
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: 03/27/2025
NARRATIVE
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The investigation revealed the following:

Allegation: Staff do not treat residents with respect

The complaint alleges that a resident had dropped her knife on the floor, a staff picked it up and threw it back on her table.

On March 27, 2025, LPA conducted interview with Facility Administrator (A1) who denied allegation and stated that all staff are trained on resident’s rights and there has been no reports of residents not being treated with dignity and respect. Lastly, A1 stated that disciplinary action would occur if a staff member was found to have not treated a resident with dignity and respect.

On March 27, 2025 between 10:15am-12:15pm, LPA interviewed staff #1-6 regarding the allegation, of those interviewed, 6 out of 6 denied the allegation; 6 out of 6 denied ever witnessing any other staff member picking up a utensil that was dropped and throwing it back on the table. Lastly, 6 out of 6 stated that they have been trained on resident rights and treat all residents with dignity and respect.

On March 27, 2025 between 12:17pm-12:45pm, LPA interviewed Resident #1-6 regarding the allegation, of those interviewed, 5 out of 6 denied allegation and 6 out of 6 stated that staff treat them with dignity and respect.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20250321091156
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: 03/27/2025
NARRATIVE
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On March 27th 2025, LPA observed meal service between 12:00-12:15. LPA observed that the Residents were treated respectfully, and servers practiced safety precautions. They wore gloves, hair nets,

On March 27, 2025, LPA reviewed and obtained a copy of client’s rights in service training certificates in addition to food handler’s certifications.

Based on the information provided, observations made, interviews conducted, and analysis of service records, LPA 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, therefore the allegation is UNSUBSTANTIATED.

No deficiencies were cited. Exit interview was conducted. A copy of this report was provided to Wellness Director Tamara Gant.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 03/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3