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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601566
Report Date: 05/11/2022
Date Signed: 05/12/2022 09:35:46 AM


Document Has Been Signed on 05/12/2022 09:35 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754



FACILITY NAME:STUDIO ROYALEFACILITY NUMBER:
198601566
ADMINISTRATOR:TERRI WEITZMANFACILITY TYPE:
740
ADDRESS:3975 OVERLAND AVENUETELEPHONE:
(310) 836-5854
CITY:CULVER CITYSTATE: CAZIP CODE:
90232
CAPACITY:175CENSUS: 93DATE:
05/11/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Terri WeitzmanTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced Case Management Visit. Upon arrival at the facility, LPA Bunker called the facility and spoke to Executive Director Terri Weitzman via telephone to conduct a risk assessment. Based on the assessment, the facility is clear of COVID-19 infection.

LPA Bunker was properly screened for COVID-19 symptoms and temperature was checked. LPA observed a sanitizing station at the facility receptionist area front entrance; visitors log with COVID-19 screening and temperature log, and records of daily COVID-19 screening and temperature checks of residents and staff.

LPA Bunker met with Executive Director Terri Weitzman and explained the primary purpose of today's visit, was to amend the Complaint Investigation Report dated 12/15/2021, Control #11-AS-20211104104311, that stated staff tested positive for COVID-19 to Reporting Requirements. LPA Bunker also, requested copies of supporting documents.

*** During today's visit, LPA Bunker experienced technical difficulties. ***

There were no deficiencies cited.

Exit interview conducted.
SUPERVISOR'S NAME: Angela J KendrickTELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela BunkerTELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:
DATE: 05/11/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/11/2022
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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