198601566-9-23-2022-11-AS-MVAO-CJQSJ6-20220929135436

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 08/01/2022
Date Signed: 09/23/2022 11:37:16 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
05/25/2022 and conducted by Evaluator Pamela Bunker

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20220525111041

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: 102	DATE:	08/01/2022
		UNANNOUNCED	TIME BEGAN:	10:30 AM
MET WITH:	Terri Weitzman		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Resident was left on the floor after falling until the next morning.
Facility does not provide a safe environment for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Monday, August 01, 2022. 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 staff 1-3 (S1-S3) and residents 1-11 ( R1-R11) were Interviewed. Allegation #1: Resident was left on the floor after falling until the next morning. Executive Director (ED) Terri Weitzman stated staff doesn't know what time R1 fell or how long she was on the floor, but there is no way she was on the floor for hours until the next morning. The facility has an awake staff that does room checks throughout the night and in the morning. Ms. Weitzman and LPA Bunker toured R1 and R2 room 222 for a health and safety check and we observed where R1 had fallen inside the room. See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022

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-20220525111041

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: STUDIO ROYALE	FACILITY NUMBER: 198601566
	VISIT DATE: 08/01/2022

NARRATIVE

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Continued LIC812-C page 2

S1-S3 stated the Med Techs are alerted if the residents call light system beep on the system, it will show what room needs help. R1's roommate would have heard R1 calling staff for assistance.

Executive Director (ED) Terri Weitzman stated that R1 is the hoarder and she fell on her side of the room. R1 was interviewed and stated it was not the staff's fault that she had fallen and she was not sure of the time or how long she was on the floor. R2 the roommate was interviewed and stated she gets up around 3:00 A.M. - 3:30 A.M., to go to the bathroom every morning. R2 stated that R1 was not on the floor at that time. R2 stated she did not hear anything and she was still sleeping when the caregiver Maria Garcia came inside the room. Caregiver Maria was interviewed and stated she walked past that room all night long and did not hear anything, there was no sound, noise, motion, or movement coming from room 222. Caregiver Maria stated that R1 and R2 are super independent and don't want staff assisting them with anything. Maria stated she found R1 on the floor that morning, and she called Med Supervisor Chanel Lee for assistance. R1 stated she was fine and did need any medical treatment.

Allegation #2 Facility does not provide a safe environment for the resident.
Staff 1-3 (1-3) and residents 1-11 (R2-R11) stated the facility does provide a safe environment for residents. R1-R11 stated they were happy living here. S1-S3 and R1-R11 stated staff checks on residents throughout the morning, day, evening, and night. S1-S3 stated residents are given a comfortable living environment and the facility provides a safe environment for all residents in care. S1-S3 and R1- R11 stated staff is providing the care and supervision necessary to meet the resident's needs.

Investigation revealed the following: Staff 1-3 (S1-S3) and residents 1-11 (R1-R11) interviewed all agreed the facility has 24-hour care and awake staff walks the hall and is always doing room checks in the middle of the night and early morning. Staff would have heard R1 if she called out for help. Ms. Weitzman stated on 05/20/2022 Resident 1 (R1) was found on the floor by the Caregiver Maria Garcia and she immediately called the Medication Supervisor Chanel Lee for assistance. Med Supervisor Chanel Lee went to room 222 to assess R1. R1 was interviewed and stated she tripped on her rug and fell on her way to the bathroom. R1 stated she doesn't know how long she was on the floor and couldn't reach the call cord to ask for help. S1-S3 stated R1 is independent they had no control over R1 falling on the floor and couldn't have prevented R1 from falling on the floor. Staff was not present during the fall. See continued LIC812-C page 3

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20220525111041

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: STUDIO ROYALE	FACILITY NUMBER: 198601566
	VISIT DATE: 08/01/2022

NARRATIVE

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Continued LIC9099-C page 3

S1-S3 stated they took the necessary precautions to assist R1 immediately once they were aware R1 was on the floor and had fallen. R1 stated it wasn't the staff's fault that she had fallen, the staff are very helpful, and are doing an excellent job. R1 stated she doesn't have a problem with the staff. R1 stated she had fallen and couldn't reach the pull cord. R1 stated she was fine and didn't need any medical attention. R1 stated later she felt dizzy and nauseous. Med Supervisor Chanel called 911. R1 was transported to Kaiser West Los Angeles. R1 was released from the hospital on 05/24/2022. R1 came back to the facility and is doing fine. S1-S3 stated that R1 is independent. R1 is getting ready to move out and into her own apartment.

Ms. Weitzman, staff, and residents interviewed stated the facility staff is providing residents with a safe environment. Ms. Weitzman stated the facility has sufficient and competent staff to provide the services needed to meet resident needs. Ms. Weitzman stated on 05/20/2022, Medication Supervisor Chanel Lee reported the incident to her prior to this complaint and she faxed the special incident report to all the appropriate agencies in a timely manner.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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, therefore the allegation is deemed unsubstantiated.

A copy of the Complaint Investigation Report LIC 9099, LIC9099-Cs, and Confidential Names LIC811 was provided to Executive Director (ED) Terri Weitzman.

There were no deficiencies cited.

An exit interview was conducted.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 08/01/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2022

LIC9099 (FAS) - (06/04)

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