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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 05/08/2026
Date Signed: 05/08/2026 09:23:41 AM

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
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:
05/08/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:WILLIAM BOLESTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff abandoned resident at the hospital.
INVESTIGATION FINDINGS:
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On 05/08/2026 Licensing Program Analyst (LPA)Jose Calderon conducted an unannounced visit to deliver an updated complaint investigation report for the allegation listed above, LPA met with William Boles and the purpose of the visit was explained. This report supersedes the report dated 08/12/2025, the investigation findings have changed to Substantiated.

The investigation consisted of the following: On 08/12/2025 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Studio Royale Facility and met with Administrator William Boles (S1). 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).
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
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-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: 05/08/2026
NARRATIVE
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The investigation revealed the following:

Regarding the Allegation: Staff abandoned residents at the hospital. This complaint alleged that the facility did not accept R1 after being medically cleared from the hospital. Records review indicate the following: The admission agreement dated 05/30/2023 states that to evict a resident who remains in his or her apartment after the effective date of termination must file an Unlawful Detainer. On 10/07/2024 the facility issued a 30-day Notice of Eviction to R1 which expired on 11/07/2024. During the investigation LPA did not observe an Unlawful Detainer in R1’s records. Interviews indicate the following: 3 out of 3 staff interviews admitted not accepting R1 back from the hospital. S1 indicates that the facility can no longer care for R1 who had cognitive issues and wanders. On 08/12/205 S1 received a phone call from the hospital regarding R1 release and S1 refused to allow R1 back into the facility. R1 no longer resides in the facility and cannot be interviewed.

Based on interviews and supporting documentation, the preponderance of evidence standard has been met therefore, the allegation of “staff abandoned resident at the hospital” is found to be SUBSTANTIATED.

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: 05/08/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/08/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/22/2026
Section Cited
CCR
87468.1(a)(2)
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87468.1(a)(2)
(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

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The administrator agreed to create a plan to ensure that residents personal rights that safe, healthful and comfortable accommodations are met after hospitalizations. Proof of correction will be submitted to jose.calderon@dss.ca.gov


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Based on records reviewed and interviews conducted, the licensee did not ensure that residents are accorded safe, healthful and comfortable accommodation. On 08/12/2025 S1 did not accept R1 who was medically cleared by the hospital. This poses a potential health, safety and personal rights risk to residents in care.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 05/08/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/08/2026
LIC9099 (FAS) - (06/04)
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