198601566-2-25-2026-11-AS-SCIS-DSSR8D-20260403124744

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198601566
Report Date: 01/14/2026
Date Signed: 02/25/2026 11:45:22 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, 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
05/09/2025 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20250509160930

FACILITY NAME:	STUDIO ROYALE		FACILITY NUMBER:	198601566
ADMINISTRATOR:	LEWIS,ERNEST D.		FACILITY TYPE:	740
ADDRESS:	3975 OVERLAND AVENUE		TELEPHONE:	(310) 836-5854
CITY:	CULVER CITY	STATE: CA	ZIP CODE:	90232
CAPACITY:	175	CENSUS: 89	DATE:	01/14/2026
		UNANNOUNCED	TIME BEGAN:	03:30 PM
MET WITH:	Bill Boles		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not follow proper eviction protocol.
Staff did not communicate care needs to resident’s representative.

INVESTIGATION FINDINGS:

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On 01/14/2026, the Department conducted a subsequent visit to gather information regarding the above allegation. The Department met with Executive Director Bill Boles, and the purpose of the visit was explained. LPA was granted entry to the facility.

The Investigation consisted of the following: On 05/14/2025 and 05/28/2025, the Department requested and reviewed the resident's records and asked for copies of the following documents: Personnel Report (dated 05/14/2025 & 05/28/2025), Resident Roster (dated 05/14/2025 & 05/28/2025), Admission Agreement (dated 04/15/2022), Identification and Emergency Information (04/15/2022), Physician's Report (dated 04/19/22 & 05/09/2025), Medical Assessment (dated 05/14/2025), Medication Administration Records (MARs) (dated 05/15/2025), Consent Forms (dated 04/15/2022), (dated 04/15/2022), Functional Capability Assessment (dated 04/15/2022), Preplacement Appraisal Information (dated 04/15/2022), Appraisal, Needs and Service Plan (dated 06/12/2024-05/12/2025), Guardian Rehabilitation HNP (12/04/2024 - 05/03/2025),
See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

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 4

Control Number 11-AS-20250509160930

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: STUDIO ROYALE	FACILITY NUMBER: 198601566
	VISIT DATE: 01/14/2026

NARRATIVE

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Continued LIC9099-C page 2.

Progress Notes (dated 04/22/2025-05/12/2025, Ideal Home Health Records (dated 05/06/2025), California Wound Healing Medical Group (dated 05/01/2025), Outside Agency Documentation (dated 02/09/2024-07/23/2024), Special Incident Reports (dated 05/08/2025), and Emails (dated 08/27/2024, 11/06/2024, 04/03/2025, and 05/04/2025).

On 05/14/2025, at 11:30 A.M., the department toured the facility buildings and grounds to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during today's visit.

On 05/14/2025, between 9:30 a.m. and 12:30 p.m., LPA Pamela Bunker conducted interviews with staff members #1–#3 (S1–S3). On 05/14/2025, at 12:30 p.m., LPA Bunker conducted interviews with resident #1 (R1) and witness #1–#2 W1-W2).

The investigation revealed the following:
Allegation: Staff did not follow proper eviction protocol
It was alleged that the staff did not follow proper eviction protocol. LPA Bunker interviewed staff members S1 through S3 (S1-S3) regarding the allegation that staff did not follow proper eviction protocol. 2 out of 3 staff members stated that the facility does follow eviction protocol and is not trying to force R1 out by having the resident taken to the hospital as a form of eviction. S1-S2 stated that R1 Case Worker stated R1 needed a higher level of care. 2 out of 3 staff stated that the facility had no records indicating that R1 received a 30-day eviction notice, nor were there any records or special incident reports stating R1 was told not to return to the facility after being discharged from the Hospital.

1 out of 3 staff stated that they did not handle eviction and had no knowledge of the allegation, and confirmed that eviction protocols are handled by the Business Office Administration, not by the caregivers.

2 out of 3 staff members interviewed reported that the facility follows proper eviction protocols, including communicating with a resident’s responsible party when an eviction notice is issued. 2 out of 3 staff members stated that the facility follows Title 22 regulations regarding the eviction process.

See continued LIC9099-C page 3.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20250509160930

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: STUDIO ROYALE	FACILITY NUMBER: 198601566
	VISIT DATE: 01/14/2026

NARRATIVE

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Continued LIC9099-C page 3.

On 05/14/2025 at 11:50 a.m., LPA interviewed both witnesses 1-2 (W1-W2) together via telephone. W1-W2 stated that the facility's Executive Director (ED), along with the Wellness Director, informed them that R1 would not be allowed to return to the facility. W1-W2 stated that R1 never received an eviction notice. They were told R1 needed a higher level of care.

On 05/14/2025 and 05/28/2025, LPA Bunker reviewed the facility records and found no documentation of a 30-day eviction notice or an updated resident assessment.

Based on interviews and documentation, the Department has no records to prove that staff failed to follow proper eviction protocol.

Allegation: Staff did not communicate care needs to the resident’s representative.
Staff members #1–#3 (S1–S3) were interviewed. 2 out of 3 staff members stated that staff communicated R1 care needs to the resident's representative. They have held meetings and discussed with family, attorney, and Ombudsman. It's in the resident's care plan, and contact was made via telephone conversation and emails outlining that they had online discussions with R1 family on 10/29/2024, 11/06/2024, 04/03/2025, and 05/04/2025. S1-S2 stated they would inform the R1 representative of any changes in R1. S1-S3 denied the allegation.

On 05/14/2025 at 11:50 a.m., LPA interviewed both witnesses 1-2 (W1-W2) together via telephone. W1-W2 stated that the staff did not communicate care needs to the resident’s representative. However, W1-W2 admitted on 05/08/2025, a meeting was held with Studio Royale, R1's family, R1's attorney, and Ombudsman during which the family requested time to find a solution to place R1 in a different facility, and the facility agreed not do anything until they spoke again on 05/09/2025.

See continued LIC9099-C page 4.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20250509160930

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: STUDIO ROYALE	FACILITY NUMBER: 198601566
	VISIT DATE: 01/14/2026

NARRATIVE

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See continued LIC9099-C page 4.

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 LIC9099 and LIC9099-C was provided to the Executive Director, Bill Boles.

No deficiencies were cited.

An exit interview was conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 01/14/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 4