198601566-3-14-2024-11-AS-SDAY-D3CUGZ-20240314153509

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198601566
Report Date: 03/14/2024
Date Signed: 03/14/2024 03:35:17 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 03/14/2024 03:35 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
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: 86	DATE:	03/14/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	E.J. Lewis		TIME COMPLETED:	03:45 PM

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	On 03/14/2024, Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced annual required visit with the CARE Inspection Tool. LPA met with Executive Director E. J. Lewis and explained the purpose of today’s visit. The facility is licensed to operate for one hundred and seventy-five (175) elderly residents ages 60 and above of which five (5) can be bedridden on the first floor and 74 non-ambulatory. The facility is approved for five (5) hospice. Currently there are 86 residents in facility. LPA reviewed 8 resident files and 5 staff files. LPA interviewed staff and residents during this visit. The facility is two stories with no memory care. There is a total of 37 resident rooms on the first floor and 57 rooms on the second floor. There is a parking area in the front and side of the facility. The lobby/receptionist area is located as you enter the building. There are two common bathrooms on each floor. The activity room is located on the first floor. The dining room is located on the first floor. The TV/Movie room are located on the first floor. The staff break room is located on the first floor. The library is located on the second floor with a computer accessible for residents. There an outside patio area with canopies and tables with chairs all along the perimeter. The salon and physical therapy room is located on the second floor. LPA and Executive Director toured the physical plant. There were no bodies of water or obstructions on the premises. Various rooms were inspected – rooms 133, 139, 141, 206, 212, 229, 231, 235, and 237, where beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. Water temperature was measured and within Title 22 regulations between 110 F and 105 F. A comfortable temperature was maintained in the facility.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle Day	TELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 03/14/2024

NARRATIVE

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LPA observed the facility to be sanitary and appropriately furnished at the time of visit. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. There is a walk in refrigerator and freezer fully stocked in the kitchen. Food deliveries are made to the facility every Tuesday and Thursday of every week. Multiple fire extinguishers were fully charged on each floor. Medication room is located on the second floor for the facility and was inspected. Laundry rooms exist on each floor.
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Fire drills are conducted monthly.

All mandated inspection control posters were posted.

No deficiencies were cited during this inspection visit.

An exit interview was conducted and a copy of this report was provided to E.J. Lewis.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle Day	TELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2024

LIC809 (FAS) - (06/04)

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