198601566-7-3-2025-11-AS-UCOL-DKMQ8W-20250817115726

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 07/03/2025
Date Signed: 07/03/2025 04:27:45 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
05/19/2025 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250519092704

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: 84	DATE:	07/03/2025
		UNANNOUNCED	TIME BEGAN:	09:09 AM
MET WITH:	Tamera Gant, Health and Wellness Director		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Staff did not dispense medication to resident as prescribed.
Staff did not assist residents with care needs in a timely manner.
Staff interfered with resident’s visits.
Staff did not provide requested records to resident's representative in a timely manner.

INVESTIGATION FINDINGS:

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On 07/03/25 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent, unannounced, complaint visit at the facility. LPA was met by staff four Tamera Gant, Health and Wellness Director (S4) and the purpose of the visit was explained.
The investigation consisted of the following:
On 05/28/25 LPA requested facility documents, including resident and staff roster (dated 05/14/25), three (3) resident records (R1, R11 and R12. Dated 03/01/25 – 05/28/25) and toured the facility. LPA interviewed six (6) out of ninety-two (92) residents (R2-R7) and five (5) out of two-hundred and eighty-three (283) staff. R1 was not available for interview, as R1 has relocated away from the facility. On 07/03/25 LPA reviewed facility and resident documents and toured the facility. LPA interviewed three (3) out of ninety-two (92) residents (R8-R10) and four (4) out of two-hundred and eighty-three (283) staff.

Report contines, see LIC9099-C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025

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-20250519092704

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: 07/03/2025

NARRATIVE

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The investigation revealed the following:
Regarding the allegation “Staff did not dispense medication to resident as prescribed.”, it is being alleged that residents’ medication has not been provided under Dr.’s orders. Record reviews have revealed the following: Medications ordered for R1, R11 and R12 match the medication administration records that have been completed by medication management staff, which also match the medications ordered by R1, R11 and R12’s physicians’. Interviews revealed the following: Seven (7) out of nine (9) residents (R2-R8) and all seven (7) staff (S1-S7) have disagreed the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.
Regarding the allegation “Staff did not assist residents with care needs in a timely manner.”, it is being alleged that staff do not provide care, as needed, to residents in care. LPA’s observations revealed the following: On 05/28/25, during LPA’s interviews with staff four (S4), in the medication room, LPA observed an emergency call from a resident’s room. LPA then heard a two-way radio for staff to investigate the same resident. Approximately four-minutes and thirty-two seconds (4:32) later, the call light had been switched off and staff have confirmed to have provided service to the same concerned resident. Interviews revealed the following: Seven (7) out of nine (9) residents (R2-R8) and all seven (7) staff (S1-S7) have disagreed the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.
Regarding the allegation “Staff interfered with resident’s visits.”, it is being alleged that staff required a resident’s visitor to leave the premises. LPA’s observations revealed the following: On 07/03/25 LPA observed a sign outside the facility, noted as follows: “Visiting hours: 08:00AM – 08:00PM. . Record reviews have revealed the following: R1’s admissions agreement (dated: 07/31/23) have noted, on page thirty-one (31) out of sixty-five (65), “Guest / Visitor Log Visits and Visting Hours. Visitors are welcome in the community. Visitor hours are 7AM to 9PM. We ask that visitors become familiar with the signing the Guest Log upon their arrival and with signing out upon leaving the community. This register helps ensure the safety of our residents and keeps management and staff aware of who is in the building in case of an emergency or natural disaster. Visitors must abide by the Community’s rules and be respectful of residents and staff. All children must be properly supervised at all times.”
Report continues, see LIC9099-C.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250519092704

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: 07/03/2025

NARRATIVE

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Interviews revealed the following: All nine (9) residents (R2-R10) and all seven (7) staff (S1-S7) have disagreed the allegation has taken place. Based on LPA’s observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.
Regarding the allegation “Staff did not provide requested records to resident's representative in a timely manner.”, it is being alleged that staff have not provided copies of a resident’s record(s) to the responsible party(ies) of a resident. Record reviews have revealed the following: a resident’s General Durable Power of Attorney, listed under section 1.01, initial agent is listed as “Agent John Doe”; yet under section 1.02, listed as “If “John Doe” fails to serve, I appoint “Jane Doe” to serve as successor Agent.”. However under section 1.04 Prior of Joint Agent Unable to Act “A successor Agent or an Agent serving jointly with another Agent may establish that the acting Agent or joint Agent is no longer able to serve as Agent by signing an affidavit that states that the Agent is not available or is incapable of acting. The affidavit must be supported by a death certificate of the Agent, a certificate showing that a guardian or conservator has been appointed for the Agent, or a letter from the Agent stating his or her unwillingness to act or delegating his or her power to the successor Agent.” all of which has never been provided to the facility or to Community Care Licensing Division. Interviews revealed the following: All nine (9) residents (R2-R10) and all seven (7) staff (S1-S7) have disagreed the allegation has taken place. Based on LPA’s observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

There have been zero (0) deficiencies cited during today's visit.

An exit interview was held with staff four, Tamera Gant Health and Wellness Director (S4) and a copy of this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
LICENSING EVALUATOR SIGNATURE:	DATE: 07/03/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2025

LIC9099 (FAS) - (06/04)

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