<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 03/08/2024
Date Signed: 03/08/2024 02:27:15 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
11/14/2022 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20221114111732
FACILITY NAME:STUDIO ROYALEFACILITY NUMBER:
198601566
ADMINISTRATOR:TERRI WEITZMANFACILITY TYPE:
740
ADDRESS:3975 OVERLAND AVENUETELEPHONE:
(310) 836-5854
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:175CENSUS: 86DATE:
03/08/2024
UNANNOUNCEDTIME BEGAN:
11:29 AM
MET WITH:Guadalupe DelgadoTIME COMPLETED:
03:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not safeguard resident's personal items.
Staff did not address resident's abusive behavior.
Staff does not prevent resident from hoarding various items.
Staff does not keep the facility free of roaches.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/07/24, at 09:00am, Licensing Program Analyst (LPA) Perry Scott conducted a subsequent unannounced visit to the facility and was greeted by Ernesto Lewis, Administrator. LPA explained the purpose of this visit is to gather additional information and deliver findings for the allegations mentioned above.

The investigation consisted of the following: An initial complaint visit was completed by LPA Jeremiah Randle on 11/18/22. A subsequent visit was completed by LPA Perry Scott on 03/07/24. LPAs investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R10). Client Roster, Staff Roster, Admissions Agreement, and Pest control invoices were obtained from the facility.

The investigation revealed the following: Allegation #1- Staff does not safeguard resident's personal items.

Report continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
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 6
Control Number 11-AS-20221114111732
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: 03/08/2024
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
The details of the complaint alleged that the facility staff does not safeguard residents’ personal items because another resident is stealing from them. On 03/07/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S4) and residents (R1-R10) regarding the allegation. 3 of 4 staff confirmed the allegation that Staff does not safeguard resident's personal items. The majority of the staff interviewed stated that there is an issue with one of the residents stealing from other residents. S1 stated that the resident involved in the ongoing theft has been counseled on the issue repeatedly and ultimately the facility had to issue an eviction notice to the resident. LPA interviewed R1-R10 about the allegation that Staff does not safeguard resident's personal items. 7 of 10 residents confirmed the allegation and stated that there is theft in the facility.

Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation: Staff does not safeguard resident's personal items, are found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) are being cited on the attached LIC 9099D.

Deficiencies are issued and plans of corrections were discussed.


Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. *

Allegation # 2- Staff did not address resident's abusive behavior.

The details of the complaint alleged that one of the residents at the facility has abusive behavior toward other residents and the facility does not address that behavior. On 03/07/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S4) and residents (R1-R10) regarding the allegation. 3 of 4 staff confirmed the of allegation that Staff did not address resident's abusive behavior. The majority of the staff interviewed stated that there has been a problem with abusive behavior from one of the residents toward other residents in the facility. LPA interviewed R1-R10 about the allegation that Staff did not address resident's abusive behavior. 7 of 10 residents confirmed the allegation and stated that a resident in the facility has been abusive verbally and physically towards them and others at one time or another.

Based on interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation: Staff did not address resident's abusive behavior, are found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) are being cited on the attached LIC 9099D.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 11-AS-20221114111732
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: 03/08/2024
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
Deficiencies are issued and plans of corrections were discussed.
Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. *

Allegation # 3- Staff does not prevent resident from hoarding various items.

The details of the complaint alleged that the facility is not preventing the resident from participating in hoarding tendencies. On 03/07/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S4) and residents (R1-R10) regarding the allegation. 4 of 4 staff confirmed the allegation that Staff does not prevent resident from hoarding various items. All staff interviewed stated that there is an issue with one of the residents’ hoarding items in their room. Staff stated that they must go in the room weekly and check that it isn’t getting to crowded with items and take those items that are not needed and dispose of them. LPA interviewed R1-R10 about the allegation that Staff does not prevent resident from hoarding various items. 7 of 10 residents confirmed the allegation and stated that there is a resident who hoards items in their room and the staff and housekeeping had to go in to clear the room out.

Based on interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation: Staff does not prevent resident from hoarding various items, are found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) are being cited on the attached LIC 9099D.

Deficiencies are issued and plans of corrections were discussed.

Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. *

Allegation # 4- Staff does not keep the facility free of roaches.

The details of the complaint alleged that the facility has roaches because of a resident’s hoarding tendencies, which the facility does not address. On 03/07/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S4) and residents (R1-R10) regarding the allegation. 2 of 4 staff confirmed the allegation that Staff does not keep the facility free of roaches. Half of the staff interviewed stated that they have seen roaches, but the facility does have a pest control company that comes out every two weeks to spray for pests. LPA interviewed R1-R10 about the allegation that Staff does not keep the facility free of roaches. 8 of 10 residents confirmed the allegation and stated the facility has a problem with roaches. LPA reviewed the pest control plan and service is being conducted bi-monthly to control the problem.

Report continued on LIC9099-C

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 11-AS-20221114111732
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: 03/08/2024
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
Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation: Staff does not keep the facility free of roaches, are found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) are being cited on the attached LIC 9099D.

Deficiencies are issued and plans of corrections were discussed.

Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. *

An exit interview was conducted with Guadalupe Delgado, Leave Concierge. Plans of corrections were discussed, and a copy of this report and appeal rights were provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 11-AS-20221114111732
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: 03/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2024
Section Cited
CCR
87217(b)
1
2
3
4
5
6
7
87217(b) Safeguards for Resident Cash, Personal Property, and Valuables. Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff…This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The administrator will develop a plan of correction on how to prevent future incidents of theft of resident's property and hold in-service training relating to theft in the facility. The licensee will submit proof of plan of correction and in-service training of staff by POC due date of 3/14/24. Submit proof to LPA Scott’s email at perry.scott@dss.ca.gov
8
9
10
11
12
13
14
Based on interviews, the administrator did not comply with this section. The facility failed to properly safeguard residents’ personal property because another resident in the facility was stealing their items, which poses a potential health risk to residents in care.
8
9
10
11
12
13
14
Type B
03/14/2024
Section Cited
CCR
87468.1(a)(3)
1
2
3
4
5
6
7
87468.1(a)(3) Personal Rights of Residents in All Facilities(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The administrator will ensure that all residents are accorded dignity in their personal relationships with staff, residents, and other persons. Facility to conduct in-service training on providing supervision appropriately to keep residents safe from abusive behavior from other residents and submit signed log of those who attended and email it to perry.scott@dss.ca.gov by POC due date of 03/14/24.
8
9
10
11
12
13
14
Based on interviews of staff and residents, the licensee failed to ensure a resident's personal rights due to a residents abusive and harassing behavior towards other residents, which poses a potential health risk to residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 11-AS-20221114111732
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: 03/08/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/14/2024
Section Cited
CCR
87468.1(a)(2)
1
2
3
4
5
6
7
Personal Rights of Residents in All Facilities (a)Residents in all residential care facilities for the elderly shall have all the following personal rights: (2) To be accorded safe, healthful, and comfortable accommodations... This requirement is not met as evidenced by:
1
2
3
4
5
6
7
The administrator will have in-service training with staff and housekeeping and develop a plan of action to combat this type of behavior in residents. The administrator will submit proof of plan of correction and in-service training of staff by POC due date of 3/14/24, to LPA at perry.scott@dss.ca.gov .
8
9
10
11
12
13
14
Based on interviews and records reviewed the facility failed to provide a safe and healthful environment for resident by allowing another resident to hoard food, boxes, and empty bottles in their room, which poses a potential health risk to residents in care.
8
9
10
11
12
13
14
Type B
03/14/2024
Section Cited
CCR
87303(a)
1
2
3
4
5
6
7
Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by:
1
2
3
4
5
6
7
Corrected during visit. Administrator provided invoices for pest control visits dated: October-December of 2022 and recent reports on a bi-monthly schedule for prevention. Administrator shall continue to use the services of a pest control company to ensure the health and safety of the residents and staff.
8
9
10
11
12
13
14
Based on documentation and interviews, the facility had roaches. LPA reviewed pest control invoices and observed that the facility had an ongoing issue with roaches in the month of October 2022 that were being treated by Dewey Pest Control bi-monthly to eradicate and control future infestations, which poses a potential health risk to residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6