198601566-11-14-2024-11-AS-UCOL-DB8TPA-20241121135401

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 11/14/2024
Date Signed: 11/14/2024 04:05:03 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, 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
11/08/2024 and conducted by Evaluator Regina Cloyd

COMPLAINT CONTROL NUMBER: 11-AS-20241108095743

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: 94	DATE:	11/14/2024
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Tamera Gant		TIME COMPLETED:	04:20 PM

ALLEGATION(S):

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Staff did not provide resident with a call button.
Staff did not ensure that resident was hydrated.
Staff did not provide responsible party with a refund.

INVESTIGATION FINDINGS:

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The investigation consisted of the following:

On 11/14/2024, Community Care Licensing Division (CCLD) Staff conducted a complaint investigation at the above facility to address the following allegations. CCLD Staff met with Health and Wellness Director Tamera Gant and explained the purpose of the visit. CCLD Staff conducted resident and staff interviews, toured the facility, and reviewed resident and facility records.

Allegation:
Regarding the allegation "Staff did not provide resident with a call button,” it is being alleged during the night shift, staff would take Resident #1’s (R1) personal call button because R1 called staff too much. Record review revealed that R1 slipped and fell on 10/12/24 9:15 AM while trying to get R1’s pendant. The incident report revealed R1 said the caregiver took R1’s pendant and placed it on R1’s desk.
Continue to LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

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 3

Control Number 11-AS-20241108095743

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: 11/14/2024

NARRATIVE

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Interview with the Health and Wellness Director (S2) indicated that R1’s pendant was removed because R1 said it was chocking R1 at night. Thus, S2 said the caregiver tied the pendant to the bedrail. S2 said R1 thought the pendant was on the end desk and R1 attempted to retrieve it resulting in a fall. S2 indicated that R1 was given a wrist pendant in response to the incident and at the request of the R1’s family. October 31, 2024 email correspondence revealed that R1 had two call buttons to return to the facility. S2 indicated that R1’s bed is on the same wall as the pull cord. CCLD Staff observed pull cords near residents’ bed and in the bathroom. Six out of six staff interviews indicated they do not remove residents’ pendants. Five out of nine resident interviews indicated that staff have not removed their pendants. Four out of nine residents said they do not have a pendant.

Regarding the allegation “Staff did not provide resident with a call button," based on record reviews, interviews, and observations, the Department 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

Allegation:

Regarding the allegation "Staff did not ensure that resident was hydrated,” it is being alleged Resident #1 (R1) had to go to the hospital due to dehydration because staff did not ensure R1 remained hydrated. Preplacement and Service Plan revealed R1 does not require assistance with meal consumption as of June 2024. Six out of six staff interviews indicated they encourage residents to stay hydrated and they provide water. Record review revealed that UTI and Hydration In-Service training was provided to staff on 06/27/24. Urinary Tract Infection (UTI) In-Service training was provided to staff on 08/14/24. Four out of nine resident interviews indicated staff does not ensure they drink plenty of water. Four out of nine residents indicated staff does ensure they drink plenty of water. One out of nine residents indicated water is offered at mealtimes. Interview with the Health and Wellness Director (S2) indicated hydration is encouraged to all residents and R1; especially when R1 receives new medication. Interview with S2 indicated residents also have pitchers or water bottles in their rooms. CDSS staff observed water stations in the bistro room, the dining room, and bottled water in residents’ room.

Continue to LIC9099-C.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20241108095743

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: 11/14/2024

NARRATIVE

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Regarding the allegation Staff did not ensure that resident was hydrated,” based on record reviews, interviews, and observations the Department 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

Allegation:

Regarding the allegation "Staff did not provide responsible party with a refund,” it is being alleged staff has not refunded $932.00 prorated rent (10/28/24 – 10/31/24). Resident #1’s (R1) Admission Agreement revealed that “you may terminate this Agreement at any time, with or without cause, by giving the Executive Director thirty (30) days’ prior written notice of termination. You will continue to be responsible for your full Monthly Fee until the thirty (30) day period has expired”. Interview with the Executive Director (S1) indicated that R1 is responsible for giving a 30-day notice and notice was given on 10/25/24. Therefore, S1 said the billing extends to November 25, 2024, R1 would not receive a refund, and R1 would be responsible for the remaining balance. S1 indicated that the balance can be waived in good-faith.

Regarding the allegation “Staff did not provide responsible party with a refund," based on record reviews and interviews, the Department 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, as a result, the allegation is Unsubstantiated.

No deficiency was cited for this allegation.

An exit interview was conducted and a copy of this report was provided to the Health and Wellness Director Tamera Gant.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina Cloyd	TELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:	DATE: 11/14/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/14/2024

LIC9099 (FAS) - (06/04)

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