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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 08/12/2025
Date Signed: 08/12/2025 03:25:39 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
08/04/2025 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20250804213549
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: 89DATE:
08/12/2025
UNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:WILLIAM BOLESTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff abandoned resident at the hospital.
INVESTIGATION FINDINGS:
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On 08/12/2025 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Studio Royale Facility and was greeted by Administrator William Boles (S1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation.

The investigation consisted of the following: LPA Calderon interviewed Staff S1-S3, residents R1-R9. LPA Calderon obtained the following records: Admission Agreement (dated 05/30/2023), Needs and Service Plan (dated 07/06/2024) Physician Report (dated 07/17/2024), 30-day eviction notice (dated 10/07/2024) for R1

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
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 2
Control Number 11-AS-20250804213549
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: 08/12/2025
NARRATIVE
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Regarding the Allegation: Staff abandoned resident at the hospital.

This complaint alleged that the facility did not pick R1 up from the hospital. Records review indicate the following: The Needs and Service plan and the Physician Report all indicate that R1 had cognitive issues. The Admission Agreement indicates on page 7-part G “Memory Care” was scratched off and no charges were found for memory care services. The 30-day notice to terminate was mailed to R1 and R1 family on 10/07/2024. Interviews indicate the following: S1 indicates that R1 had cognitive issues which the facility could no longer take care of R1 care needs. S1 indicates that the facility served R1 and R1 families with a 30-day notice to terminate. S1 indicates that S1 spoke to the hospital on 08/12/2025 and was given notice that the hospital moved R1 to a new facility and R1 wife was aware of R1 being moved. 3 out of 3 staff deny the allegation. R1 is no longer in the facility and cannot be interviewed. 8 out of 9 residents deny the allegation.

Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff abandoned resident at the hospital” is found to be UNSUBSTANTIATED.

No deficiencies cited during today's visit.



An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator William Boles (S1).
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2