198601566-7-1-2022-11-AS-UCOL-CG84DY-20220710190130

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 12/15/2021
Date Signed: 07/01/2022 08:59:43 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
11/04/2021 and conducted by Evaluator Pamela Bunker

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20211104104311

FACILITY NAME:	STUDIO ROYALE		FACILITY NUMBER:	198601566
ADMINISTRATOR:	TERRI WEITZMAN		FACILITY TYPE:	740
ADDRESS:	3975 OVERLAND AVENUE		TELEPHONE:	(310) 836-5854
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY:	175	CENSUS: 95	DATE:	12/15/2021
		UNANNOUNCED	TIME BEGAN:	11:30 AM
MET WITH:	Terri Weitzman		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Reporting requirements

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, December 15, 2021. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker met with Executive Director (ED) Terri Weitzman. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: During the course of the investigation. LPA Bunker interviewed staff 1-5 (S1-5) and residents 2-9 (R2-9). LPA Bunker asked questions relevant to the nature of the complaint. LPA Bunker requested copies of documentation regarding the above allegation. ED Ms. Weitzman provided LPA Bunker with copies of the positive COVID-19 cases, and special incident reports. Administration records, documentation, and observation of residents' records were observed. Staff stated they followed all the CDC, Public Health, and Community Care Licensing guidelines regarding COVID-19, and staff self-reported all positive cases in a timely manner. and they are adhering to Title 22 Regulations regarding Reporting requirements. See continued LIC9099-C page #2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20211104104311

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: STUDIO ROYALE	FACILITY NUMBER: 198601566
	VISIT DATE: 12/15/2021

NARRATIVE

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Continued LIC9099-C page 2

Allegation #3: Reporting requirements
Staff 1-5 (S1-5) interviewed stated they are all fully vaccinated and boosted all COVID-19 positive results cases are reported immediately to the residents, families, responsible parties, Community Care Licensing, Department of Public Health, and all the appropriate agencies in a timely manner. S1-S5 stated all COVID-19 results were self-reported prior to the complaint. S1-S5 stated they have no control over who will test positive for COVID-19. The facility is following Title 22 Regulations regarding Infection Control. S1-S5 stated staff is trained, qualified and competent on reporting requirements and is receiving ongoing training. Executive Director (ED) Terri Weitzman stated the facility has an approved Mitigation Plan Report on file. S1-S5 stated the facility will call the resident's families, responsible parties, send emails, the residents were notified door to door with a memo, and it is posted throughout the facility if a resident or staff test results are positive for COVID-19. S1-S5 stated everyone is notified if there is a positive COVID-19 case. If staff and residents had any questions staff is available to answer questions.

Interviews were conducted with residents 2-9 (R2-R9), and all stated that they are fully vaccinated and boosted that if there are positive COVID-19 results they are notified immediately. R2-R9 stated all COVID-19 cases are reported to their families, responsible parties, and representatives. R2-R9 stated that they were happy with the care and supervision they are receiving from the staff. R2-R9 stated staff care about their safety and health.

Investigation revealed the following: Staff 1-5 (1-5) and residents 2-9 (R2-9) all agreed the facility does mass COVID-19 testing for the staff and residents weekly. Executive Director (ED) Terri Weitzman stated that whenever they receive a positive COVID-19 test result it is reported to all the appropriate agencies, Community Care Licensing, Los Angeles County Department of Public Health, residents' families, responsible parties, staff, residents, and visitors are notified immediately. LPA Bunker requested, reviewed, and observed the facility Mitigation Plan Report, surveillance testing records, resident's lab reports from GENETWORx, Coronavirus SARS-CoV-2 (COVID-19) Mid Tubinate Swab, PCR) positive and negative results, Special Incident Reports (SIRs) regarding residents that tested positive for COVID-19, and physician's orders. Ms. Weitzman stated all staff and residents except one resident are fully vaccinated and boosted. The facility has the ability to quarantine either non-symptomatic or positive COVID-19 residents. The facility is following all guidance and direction regarding infection control protocol. Ms. Weitzman stated the above allegation was self-reported by the facility staff prior to the complaint in a timely manner according to Title 22 Regulations. S1-S5 stated the facility is adequately staffed, residents are assisted with their daily living, and staff is providing the necessary care and supervision to meet residents' needs. S1-S5 stated the facility staff is trained, qualified, and competent to do their jobs and receives ongoing training. Ms. Weitzman stated the facility is following Title 22 Regulations regarding Infection Control. S1-S5 and R2-R9 all denied the allegation.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 981-3347
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC9099 (FAS) - (06/04)

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