Studio Royale

Allegation investigated: Staff do not ensure resident's dietary needs are met.

On 06/26/26 at 9:30 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Executive Director Silvia Valdez as the purpose of today’s visit was explained. LPA was later joined by Regional Resident Services Director Abbygaile Macaso The investigation consisted of the following: On 06/26/26 LPA Villegas obtained copies of the staff and resident roster, facility menu for June 2026, and copies of the following documents for Resident #1 (R1) Emergency ID form, preplacement appraisal dated: 01/15/2026, Physicians report dated:01/16/26, Resident dietary preference/order form, Admission orders. On 06/26/26 from 10:00 am- 11:30 am LPA conducted Interviews with residents #1- 8 (R1-R8), on 06/26/26 at 11:30 am LPA conducted a tour of facility kitchen and observed the lunch service. On 06/26/26 from 12pm- 1pm LPA conducted interviews with staff #1-5 (S1-S5). On 06/26/26 LPA conducted a review of resident #1's file. The investigation revealed the following: Unsubstantiated Allegation: Staff do not ensure resident's dietary needs are met. It is alleged that resident in care is being provided meals that contain ingredient that resident is allergic to. On 06/26/26 from 10:00 am- 11:30 am LPA conducted Interviews with R1-R8 regarding the allegation above. 1 of the 8 residents interviewed confirmed the allegation above and stated that the kitchen staff is offering resident a soup that contains an ingredient resident is allergic to. Per 1 of the the 8 residents interviewed resident will go out into the community to purchase food when resident is aware that soup is listed on the menu for the day. 7 of 8 denied the allegation above and report they have not been sick due to the meals provided by the facility. 8 of 8 residents interviewed reported that there is an alternative menu available they can order from if they do not wish to eat the items on the menu for the day. On 06/26/26 at 11:30 am LPA conducted a tour of facility kitchen and observed the lunch service. LPA observed a big white board in the kitchen that consist of the residents names, pictures, room number, and their dietary restrictions, allergies, and the special diet that they have. During lunch service, LPA observed (2) servers each pushing a cart with lunch plates and beverages. LPA observed that some meals were cut into small pieces to accommodate the resident(s), and LPA observed alternative options being provided when requested. On 06/26/26 LPA observed that the menus for the day as well as the alternative menu was posted by the reception desk. On 06/26/26 from 12pm- 1pm LPA conducted interviews with S1-S5 regarding the allegation above. 5 of 5 staff interviewed denied the allegation above and reported there is a board on the kitchen wall that has the pictures, names, room numbers, and dietary needs of the residents. 5 of 5 staff interviewed reported they have not observed any issues with the food being served to residents in care. Additionally, 1 of 5 staff interviewed reported that kitchen staff will speak to residents about their concerns regarding food allergies and food preparation. On 06/26/26 LPA was informed by kitchen staff that soup stocks/broths are made separately for residents that have an allergy to any ingredient typically used in soup stocks/broths. On 06/26/26 LPA conducted a review of R1's file. LPA observed that R1's preplacement appraisal dated: 01/15/2026, R1's Physicians report dated:01/16/26, and R1's Resident dietary preference/order form dated: 0116/26 all state that R1 does have a food allergy. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Exit interview provided, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 26, 2026 · control 11-AS-20260618150444

Allegation investigated: Staff abandoned resident at the hospital.

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 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).the state’s words, verbatim · CDSS document, May 8, 2026 · control 11-AS-20250804213549

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: May 22, 2026

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. 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.the state’s words, verbatim · CDSS document, May 8, 2026

Plan of correction: 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

Allegation investigated: Staff do not ensure that residents have access to the facility.

On 05/07/2026 at 8:40am, the Department conducted a initial visit at this facility to deliver the complaint findings. During today's visit, the Departement met with Rhonda Madrid (Community Relations Director of Sales & Marketing) and explained the purpose of the visit. On 05/07/2026, between the hours of 9:00am - 12:24pm, the Department interviewed Administrator (A1), Staff (S1–S9), and Residents (R1–R9). The Department requested copies of the staff roster (dated 05/03/2026), & resident roster (dated 03/31/2026). The Department also obtained copies Resident 1 (R1) records, which include: LIC 601: Identification & Emergency Information (dated 03/05/2024); LIC 602: Physician's Report for RCFE (dated 07/17/2023); LIC 603A: Resident Appraisal (dated 03/05/2024); LIC 621: Resident Personal Property & Valuables (undated); LIC 605: Release of Client/Resident Medical Information (dated 03/05/2024); Pre-Authorized Debit Agreement; LIC 613: Personal Rights (dated 03/05/2024); Assisted Living Resident Handbook Acknowledgment Form (dated 03/05/2024); and the Key and Pendant Form (dated 03/05/2024). Unsubstantiated The investigation revealed the following: Allegation: Staff do not ensure that resident have access to the facility. It was alleged that exterior doors at the facility are locked overnight and that staff are not consistently available to grant access to residents returning from appointments, including early morning medical visits. It was further alleged that residents have had to wait outside for extended periods, bang on the glass to be let in, or leave the property to locate staff at another building. It was also alleged that residents previously had key access to the facility; however, management changed the locks so that only the Director and Property Manager hold keys. On 04/19/2026, a resident reportedly waited approximately 1.5 hours outside before being allowed entry. On 05/07/2026 at 12:24pm, the Department interviewed A1. A1 denied the allegation and stated that the facility maintains staff in the building 24 hours a day and that staff carry pagers connected to the front doorbell system to ensure residents have timely access to the facility. A1 reported that concierge staff are present from 6:00am -10:00pm. A1 stated that residents have never been issued master keys due to safety concerns. A1 stated not having any knowledge of any resident waiting outside for 1.5 hours on 04/19/2026 and expressed disbelief that such an incident occurred. A1 further stated that Palm Court, located across the street, offers 24-hour concierge service, and that residents have A1's personal phone number available to them. A1 reported that the facility recently audited the pager system to ensure staff compliance and confirmed that the system was functioning properly at the time of the audit. On 05/07/2026, between 9:24am - 12:02pm, the Department interviewed 9 staff members regarding the allegation. 8 out of 9 staff denied the allegation due to not being on duty at the time of reported incident occurring. Also of the 8 staff who denied the allegation mentioned not having any knowledge of any resident having waited outside for an extended period. 1 of 9 staff stated having awareness of the allegation due to a resident mentioning their difficult experience entering the facility due to recent lock changes implemented by corporate. Staff stated the facility's procedures for access in and out of the facility, include the use of the front doorbell, pagers, overnight emergency phone lines, and the expectation that care staff respond to after-hours access needs. Staff reported that doors are unlocked between the hours of 6:00am - 10:00pm and locked overnight for resident safety. Staff expressed that residents or families typically notify the facility in advance when returning late. Investigation Findings Report continues on LIC 9099-C On 05/07/2026, between 9:01am - 11:20am, the Department interviewed 9 residents regarding the allegation. 1 out of 9 residents confirmed the allegation and expressed experiencing delays and or difficulty entering the facility between the hours of 4:30am - 6:30am. 3 out of 9 residents did not confirm nor deny the allegation and expressed one time being unable to gain access into the facility but went next door at Palm Court for assistance to re-enter the facility at Studio Royale. 5 out of 9 residents denied ever having difficulty accessing the building and typically return before the doors are locked, rarely leave during late hours, or rely on call systems and established routines that allow them to avoid late-night entry situations. On 05/07/2026, between 12:22pm - 2:30pm, the Department conducted a records review and observed the following: The Department reviewed video footage from 04/19/2026, covering the time period between 5:00am - 6:09am. The footage showed that on 04/19/2026, R1 exited the facility at 5:51am. At 5:59am, as seen in the video footage, a facility housekeeper unlocked the facility doors. The Department also reviewed the Key and Pendant Form issued by Cogir Management USA, (signed & dated by R1 on 03/05/2024) which listed "N/A" for exterior key quantity and "N/A" for received, indicating that R1 was not issued an exterior key at the time of move-in. Therefore the Department did not observe any documentation to support the allegation that residents were unable to access the facility or that staff failed to respond to residents attempting to enter the facility. Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Exit interview conducted with Rhonda Madrid (Community Relations Director of Sales and Marketing) and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 7, 2026 · control 11-AS-20260501094958

Allegation investigated: Staff neglect resulted in resident developing a pressure injury. Staff retained resident requiring a higher level of care. Staff did not follow proper eviction protocol. Staff did not communicate care needs to resident’s representative.

On 03/19/2026, LPA Bunker conducted a subsequent visit to gather information regarding the above allegations. LPA Bunker 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, 05/28/2025, 01/12/2026, and 01/14/2026 LPA Bunker 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 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., Health and Wellness Director Tamera Gant and LPA Bunker 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., and on 05/28/2025, between 9:30 a.m. and 3:30 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 neglect resulted in the resident developing a pressure injury. It was alleged that staff neglect resulted in the resident developing a pressure injury. Staff members #1–3 (S1–S3) interviewed stated that R1 never disclosed a pressure injury. 3 out of 3 staff members stated they did not know about any pressure injury to R1's body. The facility was not required to bathe R1; however, the facility assisted, and R1 was bathed by his home health agency. On 08/27/2024, R1 was ambulatory until R1 sustained a fall while on a visit with his family at church. R1 required rehabilitation, which R1 received outside the facility. On 09/27/2024, Records indicate R1 developed a pressure injury while at the rehabilitation center. Studio Royale sent a representative to the rehabilitation center for evaluation before R1 returned to Studio Royale. The rehabilitation center made note that R1 was able to return to Studio Royale; however, upon R1's return to Studio Royale, it was noted that the pressure injury had not been resolved. The facility made several attempts to provide many options for R1 and communicated these options to his power of attorney (POA) with no results. Upon a scheduled doctor’s appointment, R1 was subsequently admitted to the hospital for the pressure injury. The facility staff were interviewed and denied any neglect or lack of supervision. The Department found no evidence that R1's pressure injury manifested while at the facility. See continued LIC9099-C page 2. Continued LIC9099-C page 3. S1 and S2 stated that upon admission on April 15, 2022, R1 had diagnoses that included a history of atrial fibrillation (Afib), hypertension (HTN), chronic kidney disease stage 3 (CKD3), Bell's palsy, salivary cancer, adenocarcinoma of the bladder with bilateral nephrostomy tubes, a neck fracture from a fall, hemiarthroplasty, hyperlipidemia, multiple falls, and nephrostomy. At that time, R1 was receiving in-home health care at Studio Royale. On August 27, 2024, R1 was hospitalized after falling at church. From August 27, 2024, to May 3, 2025, R1 resided in a Skilled Nursing Facility (SNF). Guardian Rehabilitation Hospital diagnosed R1 with an unstable pressure ulcer on the sacral area on the following dates: September 17, 2024, October 15, 2024, November 5, 2024, December 17, 2024, January 5, 2025, February 6, 2025, February 20, 2025, February 27, 2025, and March 6, 2025 pressure ulcer of sacral region, stage 4. On March 28, 2025, R1 had a stage 2 wound on the coccyx. On May 6, 2025, following discharge from the hospital, Ideal Home Health Care assessed R1 and identified a stage 4 wound at the facility. The Department reviewed R1 records and confirmed the documentation. Allegation: Staff retained the resident requiring a higher level of care. It was alleged that staff retained a resident who required a higher level of care. Staff members #1–#3 (S1–S3) were interviewed and stated that R1 was not retained due to needing a higher level of care. 3 out of 3 staff stated R1 was gone from the facility from August 21, 2024, to May 03, 2025. 3 out of 3 staff members stated R1 was ambulatory. When R1 returned. R1 was non-ambulatory and used a power wheelchair. On March 28, 2025, R1’s Case Manager reported that R1 had a Stage 2 wound. On May 3, 2025, when R1 returned from the hospital, the Home Health nurse assessed the wound as Stage 4. R1’s care needs increased significantly, and R1 required a higher level of care. That same day, R1 was sent back to the hospital and later returned to the facility. S1 and S2 stated they attempted to arrange a higher level of care, but R1 refused both transfer and hospice services. S1–S2 stated they would never discharge R1 without securing appropriate placement. S1–S3 also stated that they informed R1’s Power of Attorney (POA) that R1 needed a higher level of care. On May 14, 2025, the Department interviewed R1. R1 did not mention requiring a higher level of care and repeatedly questioned the purpose of the interview before walking away. See continued LIC9099-C page 4. Continued LIC9099-C page 4. On May 14, 2025, at 11:50 a.m., the Department interviewed Witnesses #1 and #2 (W1–W2) together via telephone. W1–W2 stated that staff retained R1 despite R1’s increased care needs. However, they confirmed that on May 8, 2025, a meeting occurred with Studio Royale, R1’s family, R1’s attorney, and the Ombudsman. During that meeting, the family requested additional time to find a suitable placement for R1, and the facility agreed to take no further action until after a follow-up discussion scheduled for May 9, 2025. 2 out of 3 staff members stated that staff communicated R1's care needs with R1’s POA. 3 out of 3 staff members denied the allegation. S1 and S2 stated that upon admission on April 15, 2022, R1 had diagnoses that included a history of atrial fibrillation (Afib), hypertension (HTN), chronic kidney disease stage 3 (CKD3), Bell's palsy, salivary cancer, adenocarcinoma of the bladder with bilateral nephrostomy tubes, a neck fracture from a fall, hemiarthroplasty, hyperlipidemia, multiple falls, and nephrostomy. At that time, R1 was receiving In‑Home Health Care at Studio Royale. On August 7, 2024, R1 was hospitalized after falling at church. From August 21, 2024, to May 3, 2025, R1 resided in a Skilled Nursing Facility (SNF). On September 27, 2024, R1 was diagnosed with an unstable wound. On March 28, 2025, R1 had a stage 2 wound on the coccyx. On May 6, 2025, following discharge from the hospital, Home Health Care assessed R1 and identified a stage 4 wound. The Department reviewed R1 records and confirmed the documentation. 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. See continued LIC9099-C page 5. Continued LIC9099-C page 5 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. 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 6. Continued LIC9099-C page 6. During the visits on 05/14/2025, 05/28/2025, 01/12/2026, and 01/14/2026, LPA Bunker reviewed R1’s Appraisal, Needs and Services Plan (dated 06/12/2024–05/12/2025), as well as emails dated 08/27/2024, 11/06/2024, 04/03/2025, and 05/04/2025. The Department confirmed communication between the resident’s family and facility staff. 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.the state’s words, verbatim · CDSS document, Mar 19, 2026 · control 11-AS-20250509160930

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPA met with Executive Director William "Bill" Boles and the purpose of the visit was discussed. Facility is licensed to serve 175 residents ages 60 and over, in which 74 residents may be non ambulatory, Five (5) bedridden residents may be on the 1st Floor. The facility has an approved hospice waiver for (5) residents. The facility does not handle any of the residents’ money. The facility is a two stories building. There is a total of 94 resident rooms .There is a parking area in the front and side of the facility. The 1st Floor consists of : 37 resident rooms, lobby/receptionist area, Two common bathrooms. The activity room Dining room and kitchen, TV/Movie Room, laundry and staff offices. The 2nd floor consists of: 57 resident rooms, library with a computer accessible for residents, game room, physical therapy room, Two common bathrooms and salon. Located outside is patio area with canopies and tables with chairs all along the perimeter. LPA Day and Executive Director toured the following resident bedrooms #126, #120, #132, #134, #133, #261, #259, #233 and #232 and observed all had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between 112 - 1151F. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiencies and issued a citation. Deficiencies cited under California Code of Regulations (Title 22, Division 6, Chapter 8), LPA observed the following deficiencies: -On 3/05/26 LPA Sparkle Day reviewed staff records and found that 3 out of 6 residents did not have current First Aide Certificates on file. Exit interview conducted with William Boles, Executive Director. A copy of this report was provided at time of visit.the state’s words, verbatim · CDSS document, Mar 5, 2026

Allegation investigated: Licensee does not ensure facility is free of pests. Staff are not fingerprint cleared.

** This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 01/07/26. ** On 02/18/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint investigation visit for the allegations listed above. LPA met with Executive Director, William Boles, and explained that the purpose of this visit is to provide an amended copy of the LIC9099 report. On 01/07/26, LPA Gonzalez conducted an unannounced complaint investigation visit for the allegations listed above. LPA met with Receptionist, Zoila Marroquin, and explained the purpose of the visit. LPA was granted access to the facility. Executive Director, William Boles, joined LPA for the visit shortly after. Continued on LIC9099-C Unsubstantiated The investigation consisted of the following: On 01/07/26, LPA Gonzalez collected the following documents: staff roster, resident roster, and service invoices from Dewey Pest Control dated 10/29/25 for November services, 12/16/25, and 12/26/25. LPA conducted interviews with staff #1-#7 (S1-S7), residents #1-#6 (R1-R6) and witness #1 (W1). Additionally, LPA Gonzalez and William Boles conducted a tour of the entire facility, and inspected resident rooms, the kitchen and common areas. The investigation revealed the following: Allegation: Licensee does not ensure facility is free of pests. It is being alleged that there are spiders and roaches in the kitchen. It is also being alleged that there are roaches in a couple of rooms on the second floor, and in the housekeepers carts. On 01/07/26, LPA Gonzalez conducted interviews with S1-S7. Of those interviewed, 6 out of 7 staff denied the allegation. 6 out 7 staff said pest control services are provided weekly. 6 out of 7 staff said the facility is kept clean and sanitary. On 01/07/26, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 5 out of 6 residents said the facility is free from pests. 5 out of 6 residents said they have not observed any roaches in their rooms or in the facility. 6 out of 6 residents said the facility is kept clean and sanitary. On 01/07/26, LPA Gonzalez interviewed W1, a service representative from Dewey Pest Control. W1 stated the facility has an active service contract for weekly pest control services. W1 reported that services were completed on 11/18/25, 11/25/25, 12/02/25, 12/09/25, 12/16/25, 12/23/25, and 01/06/26. On 01/07/26, LPA Gonzalez conducted a review of records, LPA reviewed pest control service invoices from Dewey Pest Control dated 10/29/25, 12/16/25, and 12/26/25. Documentation reflected that general pest control services were performed on the referenced dates. On 01/07/26, LPA and William Boles conducted a tour of the facility and inspected rooms #210, 211, and #212 on the second floor, as well as the kitchen and common areas. LPA observed the inspected areas to be clean and free of pests. Continued on LIC9099-C Based on observation, records reviewed, and interviews conducted, the department did not find 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 unsubstantiated. Allegation: Staff are not fingerprint cleared. It is alleged that staff are working in the facility without background clearance or may have felonies. On 01/07/26, LPA Gonzalez conducted interview with S1-S7. Of those interviewed, 7 out of 7 staff denied the allegation. On 01/07/26, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 6 out of 6 residents could not corroborate the allegation. On 01/07/26, LPA Gonzalez conducted a review of facility records. Five personnel files were reviewed and observed to be in order. LPA reviewed the Personnel Report (LIC 500) dated 01/07/26 and verified that all five staff members were cross-referenced through the Licensing Information System (LIS 531) and the Community Care Licensing Guardian System. Results confirmed that all staff members have obtained criminal record clearance. Additionally, it was verified that all five staff members successfully completed the criminal record background check as required by Title 22, Section 81019 (Criminal Record Clearance). Based upon records review and interviews conducted, the findings indicate that, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 18, 2026 · control 11-AS-20260102104043

Allegation investigated: Licensee does not ensure facility is free of pests. Staff are not fingerprint cleared.

** This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 01/07/26. ** On 02/18/26, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint investigation visit for the allegations listed above. LPA met with Executive Director, William Boles, and explained that the purpose of this visit is to provide an amended copy of the LIC9099 report. On 01/07/26, LPA Gonzalez conducted an unannounced complaint investigation visit for the allegations listed above. LPA met with Receptionist, Zoila Marroquin, and explained the purpose of the visit. LPA was granted access to the facility. Executive Director, William Boles, joined LPA for the visit shortly after. Continued on LIC9099-C Unsubstantiated The investigation consisted of the following: On 01/07/26, LPA Gonzalez collected the following documents: staff roster, resident roster, and service invoices from Dewey Pest Control dated 10/29/25 for November services, 12/16/25, and 12/26/25. LPA conducted interviews with staff #1-#7 (S1-S7), residents #1-#6 (R1-R6) and witness #1 (W1). Additionally, LPA Gonzalez and William Boles conducted a tour of the entire facility, and inspected resident rooms, the kitchen and common areas. The investigation revealed the following: Allegation: Licensee does not ensure facility is free of pests. It is being alleged that there are spiders and roaches in the kitchen. It is also being alleged that there are roaches in a couple of rooms on the second floor, and in the housekeepers carts. On 01/07/26, LPA Gonzalez conducted interviews with S1-S7. Of those interviewed, 6 out of 7 staff denied the allegation. 6 out 7 staff said pest control services are provided weekly. 6 out of 7 staff said the facility is kept clean and sanitary. On 01/07/26, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 5 out of 6 residents said the facility is free from pests. 5 out of 6 residents said they have not observed any roaches in their rooms or in the facility. 6 out of 6 residents said the facility is kept clean and sanitary. On 01/07/26, LPA Gonzalez interviewed W1, a service representative from Dewey Pest Control. W1 stated the facility has an active service contract for weekly pest control services. W1 reported that services were completed on 11/18/25, 11/25/25, 12/02/25, 12/09/25, 12/16/25, 12/23/25, and 01/06/26. On 01/07/26, LPA Gonzalez conducted a review of records, LPA reviewed pest control service invoices from Dewey Pest Control dated 10/29/25, 12/16/25, and 12/26/25. Documentation reflected that general pest control services were performed on the referenced dates. On 01/07/26, LPA and William Boles conducted a tour of the facility and inspected rooms #210, 211, and #212 on the second floor, as well as the kitchen and common areas. LPA observed the inspected areas to be clean and free of pests. Continued on LIC9099-C Based on observation, records reviewed, and interviews conducted, the department did not find 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 unsubstantiated. Allegation: Staff are not fingerprint cleared. It is alleged that staff are working in the facility without background clearance or may have felonies. On 01/07/26, LPA Gonzalez conducted interview with S1-S7. Of those interviewed, 7 out of 7 staff denied the allegation. On 01/07/26, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 6 out of 6 residents could not corroborate the allegation. On 01/07/26, LPA Gonzalez conducted a review of facility records. Five personnel files were reviewed and observed to be in order. LPA reviewed the Personnel Report (LIC 500) dated 01/07/26 and verified that all five staff members were cross-referenced through the Licensing Information System (LIS 531) and the Community Care Licensing Guardian System. Results confirmed that all staff members have obtained criminal record clearance. Additionally, it was verified that all five staff members successfully completed the criminal record background check as required by Title 22, Section 81019 (Criminal Record Clearance). Based upon records review and interviews conducted, the findings indicate that, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 18, 2026 · control 11-AS-20260102104043

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

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 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. 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. 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.the state’s words, verbatim · CDSS document, Jan 14, 2026 · control 11-AS-20250509160930

Allegation investigated: Staff neglect resulted in resident developing a pressure injury. Staff retained resident requiring a higher level of care.

On 01/12/2026, 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 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., and on 05/28/2025, between 9:30 a.m. and 3:30 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 (W1-W2). The investigation revealed the following. Allegation: Staff neglect resulted in the resident developing a pressure injury. It was alleged that staff neglect resulted in the resident developing a pressure injury. Staff members #1–3 (S1–S3) interviewed stated that R1 never disclosed a pressure injury. 3 out of 3 staff members stated they did not know about any pressure injury to R1's body. The facility was not required to bathe R1; however, the facility assisted, and R1 was bathed by his home health agency. R1 was ambulatory until R1 sustained a fall while on a visit with his family at church. R1 required rehabilitation, which R1 received outside the facility. Records indicate R1 developed a pressure injury while at the rehabilitation center. Studio Royale sent a representative to the rehabilitation center for evaluation before R1 returned to Studio Royale. The rehabilitation center made note that R1 was able to return to Studio Royale; however, upon R1's return to Studio Royale, it was noted that the pressure injury had not been resolved. The facility made several attempts to provide many options for R1 and communicated these options to his power of attorney (POA) with no results. Upon a scheduled doctor’s appointment, R1 was subsequently admitted to the hospital for the pressure injury. The facility staff were interviewed and denied any neglect or lack of supervision. The Department found no evidence that R1's pressure injury manifested while at the facility. See continued LIC9099-C page 2. Continued LIC9099-C page 3. Allegation: Staff retained the resident requiring a higher level of care. It was alleged that staff retained a resident who required a higher level of care. Staff members #1–#3 (S1–S3) were interviewed and stated that R1 was not retained due to needing a higher level of care. 3 out of 3 staff stated R1 was gone from the facility from August 21, 2024, to May 03, 2025. 3 out of 3 staff members stated R1 was ambulatory. When R1 returned. R1 was non-ambulatory and used a power wheelchair. R1’s Case Manager reported that R1 had a Stage 2 wound. On May 3, 2025, when R1 returned from the hospital, the Home Health nurse assessed the wound as Stage 4. R1’s care needs increased significantly, and R1 required a higher level of care. That same day, R1 was sent back to the hospital and later returned to the facility. S1 and S2 stated they attempted to arrange a higher level of care, but R1 refused both transfer and hospice services. S1–S2 stated they would never discharge R1 without securing appropriate placement. S1–S3 also stated that they informed R1’s Power of Attorney (POA) that R1 needed a higher level of care. On May 14, 2025, the Department interviewed R1. R1 did not mention requiring a higher level of care and repeatedly questioned the purpose of the interview before walking away. On May 14, 2025, at 11:50 a.m., the Department interviewed Witnesses #1 and #2 (W1–W2) together via telephone. W1–W2 stated that staff retained R1 despite R1’s increased care needs. However, they confirmed that on May 8, 2025, a meeting occurred with Studio Royale, R1’s family, R1’s attorney, and the Ombudsman. During that meeting, the family requested additional time to find a suitable placement for R1, and the facility agreed to take no further action until after a follow-up discussion scheduled for May 9, 2025. 2 out of 3 staff members stated that staff communicated R1's care needs with R1’s POA. 3 out of 3 staff members denied the allegation. 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.the state’s words, verbatim · CDSS document, Jan 12, 2026 · control 11-AS-20250509160930

Allegation investigated: Licensee does not ensure facility is free of pests. Staff are not fingerprint cleared.

On 01/07/26, LPA Gonzalez conducted an unannounced complaint investigation visit for the allegations listed above. LPA met with Receptionist, Zoila Marroquin, and explained the purpose of the visit. LPA was granted access to the facility. Executive Director, William Boles, joined LPA for the visit shortly after. The investigation consisted of the following: On 01/07/26, LPA Gonzalez collected the following documents: staff roster, resident roster, and service invoices from Dewey Pest Control dated 10/29/25 for November services, 12/16/25, and 12/26/25. LPA conducted interviews with staff #1-#7 (S1-S7), residents #1-#6 (R1-R6) and witness #1 (W1). Additionally, LPA Gonzalez and William Boles conducted a tour of the entire facility, and inspected resident rooms, the kitchen and common areas. Continued on LIC9099-C Unsubstantiated The investigation revealed the following: Allegation: Licensee does not ensure facility is free of pests. It is being alleged that there are spiders and roaches in the kitchen. It is also being alleged that there are roaches in a couple of rooms on the second floor, and in the housekeepers carts. On 01/07/26, LPA Gonzalez conducted interviews with S1-S7. Of those interviewed, 6 out of 7 staff denied the allegation. out 5 staff said pest control services are provided monthly. 6 out of 7 staff said the facility is kept clean and sanitary. On 01/07/26, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 5 out of 6 residents said the facility is free from pests. 5 out of 6 residents said they have not observed any roaches in their rooms or in the facility. 6 out of 6 residents said the facility is kept clean and sanitary. On 01/07/26, LPA Gonzalez interviewed W1, a service representative from Dewey Pest Control. W1 stated the facility has an active service contract for weekly pest control services. W1 reported that services were completed on 11/18/25, 11/25/25, 12/02/25, 12/09/25, 12/16/25, 12/23/25, and 01/06/26. On 01/07/26, LPA Gonzalez conducted a review of records, LPA reviewed pest control service invoices from Dewey Pest Control dated 10/29/25, 12/16/25, and 12/26/25. Documentation reflected that general pest control services were performed on the referenced dates. On 01/07/26, LPA and William Boles conducted a tour of the facility and inspected rooms #210, 211, and #212 on the second floor, as well as the kitchen and common areas. LPA observed the inspected areas to be clean and free of pests. Based on observation, records reviewed, and interviews conducted, the department did not find 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 unsubstantiated. Continued on LIC9099-C Allegation: Staff are not fingerprint cleared. It is alleged that staff are working in the facility without background clearance or may have felonies. On 01/07/26, LPA Gonzalez conducted interview with S1-S7. Of those interviewed, 7 out of 7 staff denied the allegation. On 01/07/26, LPA Gonzalez conducted interviews with R1-R6. Of those interviewed, 6 out of 6 residents could not corroborate the allegation. On 01/07/26, LPA Gonzalez conducted a review of facility records. Five personnel files were reviewed and observed to be in order. LPA reviewed the Personnel Report (LIC 500) dated 01/07/26 and verified that all five staff members were cross-referenced through the Licensing Information System (LIS 531) and the Community Care Licensing Guardian System. Results confirmed that all staff members have obtained criminal record clearance. Additionally, it was verified that all five staff members successfully completed the criminal record background check as required by Title 22, Section 81019 (Criminal Record Clearance). Based upon records review and interviews conducted, the findings indicate that, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 7, 2026 · control 11-AS-20260102104043

Allegation investigated: Licensee does not ensure facility is free of pest

On 1/7/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by the Executive Director, William Boles, and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility. The investigation consisted of the following: On 1/7/26 LPA Shirley reviewed copies of the following records: Staff and Resident Roster, and fumigation Invoice/Account Summaries. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff- 8(S1 – S8), and Resident -1 – Resident -5 (R1-R5). Con'd on 9099-C Unsubstantiated The investigation revealed the following: Allegation: Licensee does not ensure facility is free of pest It is being reported that there is an infestation of pest at this facility. LPA Felisa Shirley and the Executive Director toured this facility and inspected the kitchen, rooms #210, #211 and #212. Upon inspection, LPA Shirley did not observe any activity of pest. LPA Shirley reviewed fumigation invoice for 12/15/25 and observed that there was full treatment for pest. LPA Shirley also verified weekly pest control services on Tuesdays by Dewey Pest Control by phone with Service Clerk for the dates of 11/18, 11/25, 12/2, 12/9, 12/16, 12/23, and 1/6. LPA interviewed staff 1 – staff 8(S-1 – S-8). Of those interviewed 7 out of 8 denied the allegation and 1 agreed. LPA interviewed resident 1 – resident 5 (R1 – R5). Of those who interviewed 5 out of 5 denied the allegation. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Licensee does not ensure facility is free of pest,” therefore, the allegation is unsubstantiated. No deficiencies were cited for these allegations. An exit interview was conducted and a copy of this report was provided to the Executive Director, William Boles.the state’s words, verbatim · CDSS document, Jan 7, 2026 · control 11-AS-20251229085844

Allegation investigated: Licensee does not ensure facility is free of pest

On 1/7/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by the Executive Director, William Boles, and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility. The investigation consisted of the following: On 10/2/25 LPA Shirley reviewed copies of the following records: Staff and Resident Roster, and fumigation Invoice/Account Summaries. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff- 8(S1 – S8), and Resident -1 – Resident -5 (R1-R5). Con'd on 9099-C Unsubstantiated The investigation revealed the following: Allegation: Licensee does not ensure facility is free of pest It is being reported that there is an infestation of pest at this facility. LPA Felisa Shirley and the Executive Director toured this facility and inspected the kitchen, rooms #210, #211 and #212. Upon inspection, LPA Shirley did not observe any activity of pest. LPA Shirley reviewed fumigation invoice for 12/15/25 and observed that there was full treatment for pest. LPA Shirley also verified weekly pest control services on Tuesdays by Dewey Pest Control by phone with Service Clerk for the dates of 11/18, 11/25, 12/2, 12/9, 12/16, 12/23, and 1/6. LPA interviewed staff 1 – staff 8(S-1 – S-8). Of those interviewed 7 out of 8 denied the allegation and 1 agreed. LPA interviewed resident 1 – resident 5 (R1 – R5). Of those who interviewed 5 out of 5 denied the allegation. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Licensee does not ensure facility is free of pest,” therefore, the allegation is unsubstantiated. No deficiencies were cited for these allegations. An exit interview was conducted and a copy of this report was provided to the Executive Director, William Boles.the state’s words, verbatim · CDSS document, Jan 7, 2026 · control 11-AS-20251229085844

Allegation investigated: Staff stole money from resident

On 12/15/25, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by the Community Relations Dir Sales and Marketing, Rhonda Madrid and explained the purpose of the visit is to investigate and deliver findings for the allegation mentioned above. LPA was granted access to the facility. The investigation consisted of the following: On 11/21/25 LPA Shirley reviewed copies of the following records: Staff Roster, Resident Roster, Identification and Emergency Information, Physician’s Report, Resident Appraisal, Appraisals Needs and Services, Service Plan, Admission Agreement, copy of Studio Royale Theft and Loss Policy, Resident Theft and Loss Record, LIC 613 Personal Rights, and POA Documents. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff-9 (S1 – S9), and Resident -1 – Resident -8 (R1-R8). Con'd on 9099-C Unsubstantiated The investigation revealed the following: Allegation: Staff stole money from resident It is being reported that money was stolen from a resident by a member of staff. On 12/15/25, LPA Felisa Shirley reviewed Studio Royale’s Theft and Loss Policy. LPA also reviewed R1’s facility file and did not observe a completed, Resident Theft and Loss Record, (LIC 9060). Per interview with S1 on 11/21/25, there is no history of reports of theft from residents regarding staff. LPA interviewed staff 1 – staff 9 (S1 – S9). Of those interviewed 9 out of 9 denied the allegation. LPA interviewed resident 1 – resident 8 (R1 – R8). Of those who interviewed 7 out of 8 denied the allegation. 1 resident confirmed the allegation. Based on information gathered, LPA Shirley did not find sufficient evidence to support the allegation “Staff stole money from resident,” therefore, the allegation is unsubstantiated. No deficiencies were cited for this allegation. An exit interview was conducted and a copy of this report was provided to the Executive Director, William Boles.the state’s words, verbatim · CDSS document, Dec 15, 2025 · control 11-AS-20251119104403

Type of visit: Case Management - Incident

On October 28, 2025, Licensing Program Analyst- LPA Alfonso Iniguez conducted an unannounced Case Management/Incident visit at the facility. LPA Iniguez met with William Boles, Executive Director, and explained the purpose of the visit. On October 14, 2025, the Regional Office received an Unusual Incident Report or LIC 624 stating that on 10/10/25 at approximately 7:00 pm, one of the residents (R#1) reported they had been physically assaulted by two facility staff (S#1and S#2). The facility executive director (A#1) assessed (R#1), and no signs of physical injuries were observed; also, (A#1) contacted the Culver City Police Department. On October 28, 2025, LPA Iniguez spoke with (R#1), who stated that they do not remember when, but that at approximately 11:00 pm, they were asleep in bed. They were woken by someone that had physically assaulted them, (R#1) described their assailants as two African American facility staff females. LPA Iniguez asked (R#1) what they did to defend themselves, (R#1) stated that they were “throwing punches”. LPA Iniguez asked (R#1) what happened next, but (R#1) could not recall more details of what happened that “night”. On October 28, 2025, LPA Iniguez spoke with the two-facility staff (S#1 and S#2) named by (R#1). The two-facility staff member mentioned to LPA Iniguez that they only work in the day shift and they have never physically assaulted (R#1) or any other resident in care. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did not observe deficiencies during this visit; therefore, no citations were issued. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to William Boles / Executive Director.the state’s words, verbatim · CDSS document, Oct 28, 2025

Allegation investigated: Facility staff failed to provide proper supervision to the resident.

On 09/03/2025 at 8:40am, Licensing Program Analyst (LPA) Zina Brown conducted a unannounced subsequent complaint visit at this facility to deliver the complaint findings. During today’s visit, at 9:55am LPA met with William "Bill" Boles (Executive Director) and explained the purpose of the visit. The investigation consisted of the following: On 08/08/2025 at 8:05am, an initial complaint visit was conducted by the Department. On that date, LPA conducted interviews with Administrator (A1) between 12:50pm - 1:04pm, Staff (S1–S10) between 8:28am - 11:42am, Staff 11 (S11) on 08/14/2025 at 3:04 pm, Staff 12 (S12) on 08/15/2025 at 6:12pm., Staff 13 (S13) on 08/27/2025 at 11:12am, and Residents (R1–R10) between 8:39am - 1:40pm. LPA requested copies of the Resident Roster (dated 07/23/2025), Staff Roster (dated 08/05/2025), LIC 601 Identification and Emergency Information (for R10 – received 08/08/2025), LIC 602A: Medical Assessment for RCFE (for R10 – dated 08/06/2025), Plan of Care for R10 (received 08/08/2025), LIC 9172 Functional Capability Assessment (for R10 – dated 01/24/2011), Admission Agreement (for R10 – dated 05/01/2023), Personal Rights (for R10 – dated 05/01/2023), eMAR Summary (07/2025–08/2025) for R10, PCA Work Schedule (07/28/2025–08/03/2025), & Employee Time Cards for Staff 11 (S11) - Staff 13 (S13) (08/01/2025–08/02/2025). Unsubstantiated The investigation revealed the following: Allegation – Facility staff failed to provide proper supervision to the resident It was alleged that a resident of Studio Royale wandered from the facility unnoticed and was later found by the Culver City Fire Department near dumpsters, dirty, barefoot, cold, and nonverbal, raising concerns about staff supervision. On 08/08/2025, between 12:50pm - 1:04pm, LPA interviewed Administrator (A1). A1 stated it was difficult to determine when staff first became aware that Resident 10 (R10) was missing. A1 reported that R10 made her way down the hall of the south building and exited the door adjacent to the dumpster enclosure. A1 also stated that it appeared R10 exited at approximately 1:20am and there's no record of when she returned to the building. A1 also stated R10 does not have dementia and has no previous history of elopement and wandering. On 09/03/2025 at 10:05am, A1 informed LPA, effective as of 08/06/2025, R10 has one on one private care upon R10 returning to the facility from the hospital after the incident that occurred on 08/02/2025. On 08/08/2025, between 8:28am - 11:42 am, LPA interviewed Staff 1 (S1) through Staff 10 (S10). LPA also interviewed Staff 11 (S11) on 08/14/2025 at 3:04pm, Staff 12 (S12) on 08/15/2025 at 6:12pm, and Staff 13 (S13) on 08/27/2025 at 11:12am regarding the allegation. Of the 13 staff interviewed, 3 out of 10 staff confirmed the allegation. 5 out of 10 staff denied the allegation. 5 out of 10 staff were unaware of the situation. Of the 3 staff who confirmed the allegation, S4 stated the facility become aware of R10 being outside of the community upon the paramedics coming to the facility to have staff identify R10 who was unable to identify themselves. Of the 10 staff who denied the allegation and were unaware of the allegation, the staff stated that they were not schedule to work nor present at the time of the incident occurring. On 08/08/2025, between 8:39am - 1:40pm, LPA interviewed Resident 1 (R1) through Resident 10 (R10). 9 out of 10 residents denied the allegation. 1 out of 10 residents were unsure about the allegation. Of the 10 residents, the 9 residents who denied the allegation stated not having any knowledge of the allegation occurring while the 1 resident who was unsure of the allegation could not recall the allegation occurring. Report continues on LIC 9099-C. On 09/02/2025, between 3:10pm - 4:00pm, LPA conducted a records review and observed the following: The Department received the LIC 624 Unusual Incident/Injury Report (dated 08/06/2025) for the incident that occurred on 08/02/2025 at around 6:00am. The report stated R10 was found by the Community Medication Technician lying on the ground near the dumpster across the street from the community. R10 was transported to SoCal Hospital Culver City Emergency Room. The LIC 624 also stated R10 is assessed by the Community Nurse twice a year and as needed for changes in condition, with care plans updated and implemented accordingly. R10’s current plan has been updated as of 08/06/2025 with additional care to meet her needs. The LIC 602A: Medical Assessment for RCFE (for R10 – dated 08/06/2025) on page 5 of 9 under Section 2: Capacity for Self-Care – H. Able to leave facility unsupervised (considering physical or cognitive abilities)is checked “No,” as R10 has a history of multiple falls. However, before the incident that occurred on 08/02/2025, R10’s previous LIC 602A: Medical Assessments (dated 01/08/2024 and 04/25/2023) on page 4 of 6 under Section 14: Mental Condition – Letter K. Able to leave the facility unsupervised was checked “Yes.” Based on interviews and record reviews conducted, there is not enough evidence to support that facility staff failed to provide proper supervision to the resident. Therefore, the allegation is UNSUBSTANTIATED. 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 UNSUBSTANTIATED. An exit interview was conducted with William "Bill" Boles (Executive Director) and a copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 3, 2025 · control 11-AS-20250804132850

Allegation investigated: Staff abandoned resident at the hospital.

On 08/12/2025 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Studio Royale Facility and was greeted by Administrator William Boles (S1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation. The investigation consisted of the following: 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) for R1 The investigation revealed the following: Unsubstantiated Regarding the Allegation: Staff abandoned resident at the hospital. This complaint alleged that the facility did not pick R1 up from the hospital. Records review indicate the following: The Needs and Service plan and the Physician Report all indicate that R1 had cognitive issues. The Admission Agreement indicates on page 7-part G “Memory Care” was scratched off and no charges were found for memory care services. The 30-day notice to terminate was mailed to R1 and R1 family on 10/07/2024. Interviews indicate the following: S1 indicates that R1 had cognitive issues which the facility could no longer take care of R1 care needs. S1 indicates that the facility served R1 and R1 families with a 30-day notice to terminate. S1 indicates that S1 spoke to the hospital on 08/12/2025 and was given notice that the hospital moved R1 to a new facility and R1 wife was aware of R1 being moved. 3 out of 3 staff deny the allegation. R1 is no longer in the facility and cannot be interviewed. 8 out of 9 residents deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff abandoned resident at the hospital” is found to be UNSUBSTANTIATED. No 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).the state’s words, verbatim · CDSS document, Aug 12, 2025 · control 11-AS-20250804213549

Type of visit: Case Management - Deficiencies

On 08/08/2025 at 8:05am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced case management deficiencies. During the complaint investigation, LPA observed Staff # 1 (S1) was not associated to the facility at the time of unannounced complaint investigation. Civil penalties assessed and a deficiency is being cited under California Code of Regulation Title 22, Division 6, Chapter 8 are being cited on the LIC 809-D. Exit interview conducted with William "Bill" Boles, Executive Director and a copy of this report was provided with appeal rights.the state’s words, verbatim · CDSS document, Aug 8, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87355(e)(2) · Plan of correction due date: Aug 10, 2025

Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2)Obtain a California clearance or a criminal record exemption as required by the Department Based on observation and interview, staff Neyba Padilla was not associated to the facility as the time of unannounced complaint investigation which poses an immediate health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 8, 2025

Plan of correction: The facility shall associate staff in Guardian and submit proof of update via email at zina.brown@dss.ca.gov by POC due date.

Allegation investigated: Staff did not dispense medication to resident as prescribed. Staff did not assist residents with care needs in a timely manner. Staff interfered with resident’s visits. Staff did not provide requested records to resident's representative in a timely manner.

On 07/03/25 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent, unannounced, complaint visit at the facility. LPA was met by staff four Tamera Gant, Health and Wellness Director (S4) and the purpose of the visit was explained. The investigation consisted of the following: On 05/28/25 LPA requested facility documents, including resident and staff roster (dated 05/14/25), three (3) resident records (R1, R11 and R12. Dated 03/01/25 – 05/28/25) and toured the facility. LPA interviewed six (6) out of ninety-two (92) residents (R2-R7) and five (5) out of two-hundred and eighty-three (283) staff. R1 was not available for interview, as R1 has relocated away from the facility. On 07/03/25 LPA reviewed facility and resident documents and toured the facility. LPA interviewed three (3) out of ninety-two (92) residents (R8-R10) and four (4) out of two-hundred and eighty-three (283) staff. Report contines, see LIC9099-C. Unsubstantiated The investigation revealed the following: Regarding the allegation “Staff did not dispense medication to resident as prescribed.”, it is being alleged that residents’ medication has not been provided under Dr.’s orders. Record reviews have revealed the following: Medications ordered for R1, R11 and R12 match the medication administration records that have been completed by medication management staff, which also match the medications ordered by R1, R11 and R12’s physicians’. Interviews revealed the following: Seven (7) out of nine (9) residents (R2-R8) and all seven (7) staff (S1-S7) have disagreed the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation “Staff did not assist residents with care needs in a timely manner.”, it is being alleged that staff do not provide care, as needed, to residents in care. LPA’s observations revealed the following: On 05/28/25, during LPA’s interviews with staff four (S4), in the medication room, LPA observed an emergency call from a resident’s room. LPA then heard a two-way radio for staff to investigate the same resident. Approximately four-minutes and thirty-two seconds (4:32) later, the call light had been switched off and staff have confirmed to have provided service to the same concerned resident. Interviews revealed the following: Seven (7) out of nine (9) residents (R2-R8) and all seven (7) staff (S1-S7) have disagreed the allegation has taken place. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation “Staff interfered with resident’s visits.”, it is being alleged that staff required a resident’s visitor to leave the premises. LPA’s observations revealed the following: On 07/03/25 LPA observed a sign outside the facility, noted as follows: “Visiting hours: 08:00AM – 08:00PM. . Record reviews have revealed the following: R1’s admissions agreement (dated: 07/31/23) have noted, on page thirty-one (31) out of sixty-five (65), “Guest / Visitor Log Visits and Visting Hours. Visitors are welcome in the community. Visitor hours are 7AM to 9PM. We ask that visitors become familiar with the signing the Guest Log upon their arrival and with signing out upon leaving the community. This register helps ensure the safety of our residents and keeps management and staff aware of who is in the building in case of an emergency or natural disaster. Visitors must abide by the Community’s rules and be respectful of residents and staff. All children must be properly supervised at all times.” Report continues, see LIC9099-C. Interviews revealed the following: All nine (9) residents (R2-R10) and all seven (7) staff (S1-S7) have disagreed the allegation has taken place. Based on LPA’s observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. Regarding the allegation “Staff did not provide requested records to resident's representative in a timely manner.”, it is being alleged that staff have not provided copies of a resident’s record(s) to the responsible party(ies) of a resident. Record reviews have revealed the following: a resident’s General Durable Power of Attorney, listed under section 1.01, initial agent is listed as “Agent John Doe”; yet under section 1.02, listed as “If “John Doe” fails to serve, I appoint “Jane Doe” to serve as successor Agent.”. However under section 1.04 Prior of Joint Agent Unable to Act “A successor Agent or an Agent serving jointly with another Agent may establish that the acting Agent or joint Agent is no longer able to serve as Agent by signing an affidavit that states that the Agent is not available or is incapable of acting. The affidavit must be supported by a death certificate of the Agent, a certificate showing that a guardian or conservator has been appointed for the Agent, or a letter from the Agent stating his or her unwillingness to act or delegating his or her power to the successor Agent.” all of which has never been provided to the facility or to Community Care Licensing Division. Interviews revealed the following: All nine (9) residents (R2-R10) and all seven (7) staff (S1-S7) have disagreed the allegation has taken place. Based on LPA’s observations, record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated. There have been zero (0) deficiencies cited during today's visit. An exit interview was held with staff four, Tamera Gant Health and Wellness Director (S4) and a copy of this report has been provided.the state’s words, verbatim · CDSS document, Jul 3, 2025 · control 11-AS-20250519092704

Allegation investigated: Staff do not treat residents with respect

**This report will supersede report dated March 27,2025. This report will not change findings; the purpose is to clarify the findings** On May 29, 2025 Licensing Program Analyst (LPA) Deborah Lee conducted a subsequent complaint visit to clarify and deliver findings. LPA was greeted by Tamara Gant who granted access to the facility and the purpose of the visit was explained. The investigation consisted of the following: On March 27, 2025, LPA and staff Lupe Delgado conducted a tour of facility, observations made, LPA reviewed and obtained copies of the following: client roster(dated 3/2/25 ), staff roster (dated 5/6/24 ), staff training certificates on resident's rights (various dates: 1/17/25, 2/27/25, 3/5/35, 3/15/25,3/18/25), Food Handlers certificates for all kitchen staff, Appraisal/Needs and Services plans for (R1) dated 4/11/24 ,Physicians report for (R1), dated 4/20/24 ; interviews were conducted with Facility Administrator, 6 staff, and 6 Residents. Page 1 of 3 Unsubstantiated The investigation revealed the following: Allegation: Staff do not treat residents with respect The complaint alleges that a resident had dropped her knife on the floor, a staff picked it up and threw it back on her table. On March 27, 2025, LPA conducted interview with Facility Administrator (A1) who denied allegation and stated that all staff are trained on resident’s rights and there has been no reports of residents not being treated with dignity and respect. Lastly, A1 stated that disciplinary action would occur if a staff member was found to have not treated a resident with dignity and respect. On March 27, 2025, between 10:15am-12:15pm, LPA interviewed staff #1-6 regarding the allegation, of those interviewed, 6 out of 6 denied the allegation; 6 out of 6 denied ever witnessing any other staff member picking up a utensil that was dropped and throwing it back on the table. Lastly, 6 out of 6 stated that they have been trained on resident rights and treat all residents with dignity and respect. On March 27, 2025, between 12:17pm-12:45pm, LPA interviewed Resident #1-6 regarding the allegation, of those interviewed, 5 out of 6 denied allegation and 6 out of 6 stated that staff treat them with dignity and respect. Page 2 of 3 On March 27, 2025, LPA observed meal service between 12:00-12:15. LPA observed that the Residents were treated respectfully, and servers practiced safety precautions by wearing gloves, masks, and hair nets while serving and interacting with the residents. On March 27, 2025, LPA reviewed and obtained a copy of client’s rights in service training certificates in addition to food handler’s certifications. Based on the information provided, observations made, interviews conducted, and analysis of service records, LPA found no evidence to support the allegation mentioned above. 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 UNSUBSTANTIATED. No deficiencies were cited. Exit interview was conducted. A copy of this report was provided to Tamara Gant. Page 3 of 3the state’s words, verbatim · CDSS document, May 29, 2025 · control 11-AS-20250321091156

Type of visit: Required - 1 Year

On 03/14/2024, Licensing Program Analyst (LPA) Yolanda Rosser conducted an unannounced annual required visit with the CARE Inspection Tool. LPA met with Health and Wellness Director, Tamera Grant and explained the purpose of today’s visit. Later LPA met with Executive Director, William Boles, JR. The facility is licensed to operate for one hundred and seventy-five (175) elderly residents ages 60 and above of which five (5) can be bedridden on the first floor and 74 non-ambulatory. The facility is approved for five (5) hospice. Currently there are 94 residents in facility. The facility is two stories with no memory care. There is a total of 37 resident rooms on the first floor and 57 rooms on the second floor. There is a parking area in the front and side of the facility. The lobby/receptionist area is located as you enter the building. There are two common bathrooms on each floor. The activity room is located on the first floor with plenty of activities including board games, cards, checkers, chess board games for the residents leisure. The dining room is located on the first floor with ample seating for clients and /or guests. The TV/Movie room are located on the first floor. The staff break room is located on the first floor. The library is located on the second floor with a computer accessible for residents. Located outside is patio area with canopies and tables with chairs all along the perimeter. The salon and physical therapy room is located on the second floor. LPA found the facility to be maintained adequately, art covering the walls, piano located in the foyer, music playing in the background. LPA and Health and Wellness Director toured the physical plant. There were no bodies of water or obstructions on the premises. Various rooms were inspected – where beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. Water temperature was measured and within Title 22 regulations between 108 degrees F and 110 degrees F. Cont'd on C page. A comfortable temperature was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. There is a walk in refrigerator and freezer fully stocked in the kitchen. Food deliveries are made to the facility every Tuesday and Thursday of every week. Multiple fire extinguishers were fully charged on each floor. Medication room is located on the second floor for the facility and was inspected. Laundry rooms exist on each floor. . Fire drills are conducted monthly. All mandated inspection control posters were posted. No deficiencies were cited during this inspection visit. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 2, 2025

Allegation investigated: Staff do not treat residents with respect

On March 27, 2025 Licensing Program Analyst (LPA) Deborah Lee conducted an unannounced complaint visit to address the allegation listed above. LPA was greeted by Tamara Gant, Wellness Director who granted access to the facility and the purpose of the visit was explained. Bill Boles, Executive Director subsequently arrive to speak with LPA. The investigation consisted of the following: On March 27, 2025, LPA and staff Lupe Delgado conducted a tour of facility, observations made, LPA reviewed and obtained copies of the following: client roster(dated 3/2/25 ), staff roster (dated 5/6/24 ), staff training certificates on resident's rights (various dates: 1/17/25, 2/27/25, 3/5/35, 3/15/25,3/18/25), Food Handlers certificates for all kitchen staff, Appraisal/Needs and Services plans for (R1) dated 4/11/24 ,Physicians report for (R1), dated 4/20/24 ; interviews were conducted with Facility Administrator, 6 staff, and 6 Residents page 1 of 3 Unsubstantiated The investigation revealed the following: Allegation: Staff do not treat residents with respect The complaint alleges that a resident had dropped her knife on the floor, a staff picked it up and threw it back on her table. On March 27, 2025, LPA conducted interview with Facility Administrator (A1) who denied allegation and stated that all staff are trained on resident’s rights and there has been no reports of residents not being treated with dignity and respect. Lastly, A1 stated that disciplinary action would occur if a staff member was found to have not treated a resident with dignity and respect. On March 27, 2025 between 10:15am-12:15pm, LPA interviewed staff #1-6 regarding the allegation, of those interviewed, 6 out of 6 denied the allegation; 6 out of 6 denied ever witnessing any other staff member picking up a utensil that was dropped and throwing it back on the table. Lastly, 6 out of 6 stated that they have been trained on resident rights and treat all residents with dignity and respect. On March 27, 2025 between 12:17pm-12:45pm, LPA interviewed Resident #1-6 regarding the allegation, of those interviewed, 5 out of 6 denied allegation and 6 out of 6 stated that staff treat them with dignity and respect. Page 2 of 2 On March 27th 2025, LPA observed meal service between 12:00-12:15. LPA observed that the Residents were treated respectfully, and servers practiced safety precautions. They wore gloves, hair nets, On March 27, 2025, LPA reviewed and obtained a copy of client’s rights in service training certificates in addition to food handler’s certifications. Based on the information provided, observations made, interviews conducted, and analysis of service records, LPA found no evidence to support the allegation mentioned above. 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 UNSUBSTANTIATED. No deficiencies were cited. Exit interview was conducted. A copy of this report was provided to Wellness Director Tamara Gant. Page 3 of 3the state’s words, verbatim · CDSS document, Mar 27, 2025 · control 11-AS-20250321091156

Allegation investigated: Staff did not provide a lawful eviction notice to resident in care.

On January 21,2025, an associate from the California Department of Social Services/Community Care Licensing (CDSS/CCL) conducted a subsequent, unannounced complaint visit. The Executive Director, William Boles, greeted the associate. The associate explained that the purpose of this visit was to investigate the allegation mentioned above. The investigation included a tour of the facility, interviews, and the collection of records. Interviews were conducted with staff members #1, #2 and #3 (S1-S3). The associate reviewed several documents, including the Personnel Report LIC 500 (dated 05/16/24), the Facility Roster (dated 10/05/24), the 30-Day to Terminate Tenancy Notice (dated 03/05/24), and other pertinent records associated with this complaint. (Evaluation Report continues LIC 9099-C) Substantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff did not provide a lawful eviction notice to resident in care. The complaint asserted that the facility issued an unlawful eviction notice to Resident #1 (R1). The complaint specified that management had reached a final decision to cease collaboration with (R1) and was no longer willing to accept further payments for services. It was reported that (R1) received a 30-Day Eviction Notice that did not adhere to the requirements set forth by the California State Department of Social Services Community Care Licensing (CDSS/CCL) Title 22 Regulations. On April 9, 2024, between 9:00 AM and 3:00 PM, the Department conducted interviews with two staff members, designated as Staff #1 and Staff #2, concerning the allegation that (R1) had failed to comply with the facility's general policies. Staff #1 indicated that (R1) exhibited behaviors that were prohibited and adversely affected other residents and the community. Additionally, according to Staff #2, (R1) is an accumulator who collects unsanitary items, which are subsequently brought back to the room. Staff #1 maintained that the eviction notice issued to (R1) was compliant with Title 22 Regulations, stating that such action was necessitated by (R1's) inappropriate behaviors and the impact on the health and safety of other residents. On January 17, 2025, between 1:30 PM and 3:30 PM, the Department interviewed a staff member identified as Staff #3 regarding this allegation. Staff #3 reported that (R1) was relocated from the facility on April 5, 2024, with assistance from the placement agency Brightside Referrals, and is currently no longer residing at Studio Royale. Staff #3 also noted that the eviction notice and (R1's) departure from the facility occurred prior to (S3's) employment with Studio Royale. An additional interview with Staff #1 was not feasible, as (S1) is no longer employed with Studio Royale and no forwarding contact information was provided. The Department was likewise unable to interview Resident #1 (R1) due to the absence of forwarding contact information. The Department's review of service files and the 30-Day Notice to Terminate Tenancy (dated 03/05/24) revealed that management issued an invalid eviction notice, failing to comply with (CDSS/CCL) Title 22 Regulations concerning eviction procedures. (Evaluation Report continues LIC 9099-C) The eviction notice was found to be incomplete, lacking several critical pieces of information, resources available to assist with alternative housing and care options, referral services for alternative housing, and confirmation that a written eviction notice should be submitted to the licensing agency within five days. The Department concluded that there is sufficient evidence to substantiate the allegation based on information gathered from facility inspections, observations, interviews, and records analysis. Consequently, the allegation regarding the violation of personal rights, specifically that "Staff did not provide a lawful eviction notice to a resident in care," has been deemed substantiated. An exit interview was conducted with William Boles, during which copies of the reports were distributed along with appeal rights.the state’s words, verbatim · CDSS document, Jan 21, 2025 · control 11-AS-20240404155510

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87224(B)(1-2)(f) · Plan of correction due date: Feb 4, 2025

87224(B) Resources available to assist in identifying alternative housing and care options... 1. Referral services that will aid in finding alternative housing. 2. Case management... help manage individual care and service needs. (f) A written report of any eviction shall be sent to the licensing agency within five (5) days. This requirement was not met as evidence by: Based on interviews and record reviews, the Licensee failed to issue a valid eviction notice in compliance with Title 22 Regulations. This violation poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 21, 2025

Plan of correction: The licensee agrees to submit a Plan of Correction (POC) to the California Community Care Licensing Division (CCLD) by 02/04/25. The licensee will review Title 22 87244 regarding Eviction Procedures and provide a written statement confirming that the review has been completed and will comply with this regulation. The POC should be sent to LPA Dabuet at ernand.dabuet@dss.ca.gov by the specified date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(D) · Plan of correction due date: Feb 4, 2025

87211-(a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following:(D) Any incident which threatens the welfare, safety or health of any resident...abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not met as evidence by: Based on interviews and record reviews, the Licensee failed to report incidents involving (R1's) health and safety welfare. This violation poses a potentinal health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jan 21, 2025

Plan of correction: The licensee agrees to submit a Plan of Correction (POC) to the California Community Care Licensing Division (CCLD) by 02/04/25. The licensee will review Title 22 87211 regarding Reporting Requirements and will comply with this regulation. The POC should be sent to LPA Dabuet at ernand.dabuet@dss.ca.gov by the specified date.rovide a written statement confirming that the review has been completed and

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87405(b)(2) · Plan of correction due date: Feb 4, 2025

87405(b)(2) Administrator-Qualifications and Duties. (b) The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. (2) Knowledge of and ability to conform to the applicable laws, rules and regulations. This requirement was not met as evidenced by: Based on interview and record reviews the administrator failed to adhere to Title 22 regulations, resulting to multiple citations. This violation poses a potential health and safety to residents in care.the state’s words, verbatim · CDSS document, Jan 21, 2025

Plan of correction: The licensee/administrator will create a plan to ensure that the administrator performs knowledge of and conform to applicable laws, rules and regulations. A written statement from licensee that reviewed 87405 POC will be sent to LPA Dabuet by 02/04/25 at ernand.dabuet@dss.ca.gov

Allegation investigated: Staff did not address a resident's change in medical condition

On 1/9/25, Licensing Program Analyst, (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by Health and Wellness Director, Tamera Gant and explained the purpose of the visit is to investigate the allegation mentioned above. LPA was granted access to the facility. The investigation consisted of the following: LPA Shirley requested and received copies of the following: Staff Roster, Resident Roster, resident files, Out of the Community list, ID and Emergency Information, Physicians Report, Preplacement Appraisal, California HSE Results, Medication List, Incident Log, Email communications and Progress Notes. LPA interviewed S1 thru S8 and R1 thru R5. The investigation revealed the following: Con'd on 9099-C Unsubstantiated Allegation: Staff did not address a resident's change in medical condition It was reported that staff is not addressing a residents change in medical condition. LPA Shirley spoke with S-1 and was told that R-1’s care services were updated 9/22/24. Resident was being assisted with showers and dressing. LPA Shirley reviewed progress notes for R-1 which are updated periodically and as needed. LPA Shirley observed that on 11/18/24, hospice came for an evaluation for signs of decline. Hospice stated that they didn’t see any signs of further decline. On 12/13/24, R-1 was discharged from hospice services as resident was doing fine. Per S-1, R-1 has a personal companion to assist her 4 hours per day with day-to-day activities of daily living. Per interview with S-1, resident began refusing to eat, showed signs of becoming weaker and requested to stay in bed. On 12/21/24, per progress notes resident was feeling pain in her leg. Per S-1, R-1 had several falls going to and from the bathroom and transferring in and out of the bed. Per S-1, additional services were placed on the care services for R-1. Per interview with S-1 hospice nurse came for evaluation on 1/4/25 and R-1 was placed back on Kaiser hospice. LPA Shirley observed several communications between staff and a family member requesting to meet. On 1/9/25, during interview S-1 had to leave conference room as R-1’s family member requested a meeting regarding the resident’s care. LPA interviewed staff-1 thru staff-8 (S-1 thru S-8). LPA ask, does staff address a residents change in medical condition? Of those interviewed, 8 out of 8 answered yes. LPA interviewed resident -1 thru resident - 5 (R-1 thru R-5). LPA ask, does staff address residents change in medical condition. Of those interviewed, 4 out of 5 answered yes and 1 answered, sometimes. Based on information gathered, LPA did not find sufficient Con'd on 9099-C evidence to support the allegation “Staff did not address a residents change in medical condition,” therefore this allegation is unsubstantiated. There were no deficiencies observed during this visit. LPA Shirley conducted an exit interview, and a copy of this report was signed by the Health and Wellness Director, Tamera Gant.the state’s words, verbatim · CDSS document, Jan 9, 2025 · control 11-AS-20241230150951

Allegation investigated: Facility failed to ensure staff were adequately trained in emergency evacuation.

On 11/15/24, California Department of Social Services/Community Care Licensing (CDSS/CCL) associate conducted an initial unannounced complaint visit. (CDSS/CCL) associate was greeted by Wellness Director Tamera Gant. (CDSS/CCL) associate explained the purpose of this visit was to investigate the allegation mentioned above. The investigation consisted of the following: A tour of the physical plant, interviews, and collection of records. Interviews with staff #1-#3 (S1-S3) and residents #1-#9 (R1-R4). A review of Personnel Report LIC 500 dated: 0516/24), Faciltiy Roster (dated: 10/05/24), Staff Schedule, Emergency Disaster Plan for Residential Care Facilities LIC 610E (dated: 05/15/24), Fire Drill Report (dated: 06/17/24, 06/18/24, & 08/27/24) Disaster and Emergency Manual (dated: 03/01/22), and Fire & Evacuation Plan (dated: 09/12/24) (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Facility failed to ensure staff were adequately trained in emergency evacuation. The details of the complaint alleged the facility staff are not adequately trained in the event of emergency evacuation. It is reported on 11/7/24 at approximately 5:00 pm, the facility staff were uninformed on how to handle Emergency Evacuation when the fire alarm went off. There was no facility staff to assist residents with mobility who were deemed non-ambulatory by their medical doctor and were unable to safely descend from the stairwells timely. Although it was determined it was a false alarm, there would not have been trained staff to help the residents who needed assistance on the second floor. On 11/15/24, between 09:30 am - 03:10 pm, the Department interviewed (3) out of (3) staff who claimed this allegation was false. Staff #1 (S1) stated that care partner staff are trained in Disaster and Emergency Procedures. (S1) expressed that on 11/7/24 the facility fire alarm was set off by a resident. (S1) stated there was no fire and it was a false alarm. (S1) said they had to dispatch the local Fire Department to turn off the alarm and that process took about 15 minutes to complete. (S1) reported that there is no shortage of care partner staff to work on each shift. The AM and PM shifts had four (4) to five (5) staff, while the overnight shift had three (3) or four (4) overseeing both floors. The non-care provider staff are also cross-trained as care providers in the event of a staffing crisis. (S1) stated that the second-floor stairs are equipped with Emergency Evacuation Chairs. (S2-S3) confirmed working on 11/07/24 and assisted with notifying or escorting residents to safety. On 11/15/24, between 11:00 am - 12:30 pm, the Department interviewed (8) out of (9) residents were unable to corroborate this accusation. Three (3) out of nine (9) noted that staff participated and collaborated with the management staff to assist in guiding directions for residents to safety. Five (5) out of nine (9) residents claimed they were informed in person that it was a false alarm. Eight (8) out of (9) expressed that they had no concern for their safety living at this facility. Resident #9 (R9) refused to participate in an interview. Residents #1-#9 (R1-R9) are all residents residing on the second floor of this facility. As a result of the Department reviewing the facility's Personnel Report LIC 500 (dated: 05/16/24), Facility Roster (dated: 10/05/24), Staff Schedule (dated: 11/4/24-11/10/24), Emergency Disaster Plan for Residential Care Facilities LIC 610E (dated: 05/15/24), Fire Drill Report (dated: 06/17/24, 06/18/24, & 08/27/24), (Evaluation Report continues LIC 9099-C) Disaster and Emergency Manual (dated: 03/01/22), and Fire & Evacuation Plan, revealed sufficient staffing on each shift and that staff have completed training on emergency and disaster preparedness and procedures. The Department observed three (3) Emergency Evacuated Chairs. Based on the information gathered, there is no sufficient evidence to support the allegation mentioned in this complaint. Based on the information collected, an inspection of the facility, observation and interviews conducted, and an analysis of records reviewed, the Department found no evidence to support the allegation mentioned in this complaint. 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 Unsubstantiated. An exit interview is conducted with Wellness Director Tamera Gant, and a copy of the report is provided.the state’s words, verbatim · CDSS document, Nov 15, 2024 · control 11-AS-20241108163340

Allegation investigated: Staff did not provide resident with a call button. Staff did not ensure that resident was hydrated. Staff did not provide responsible party with a refund.

The investigation consisted of the following: On 11/14/2024, Community Care Licensing Division (CCLD) Staff conducted a complaint investigation at the above facility to address the following allegations. CCLD Staff met with Health and Wellness Director Tamera Gant and explained the purpose of the visit. CCLD Staff conducted resident and staff interviews, toured the facility, and reviewed resident and facility records. Allegation: Regarding the allegation "Staff did not provide resident with a call button,” it is being alleged during the night shift, staff would take Resident #1’s (R1) personal call button because R1 called staff too much. Record review revealed that R1 slipped and fell on 10/12/24 9:15 AM while trying to get R1’s pendant. The incident report revealed R1 said the caregiver took R1’s pendant and placed it on R1’s desk. Continue to LIC9099-C. Unsubstantiated Interview with the Health and Wellness Director (S2) indicated that R1’s pendant was removed because R1 said it was chocking R1 at night. Thus, S2 said the caregiver tied the pendant to the bedrail. S2 said R1 thought the pendant was on the end desk and R1 attempted to retrieve it resulting in a fall. S2 indicated that R1 was given a wrist pendant in response to the incident and at the request of the R1’s family. October 31, 2024 email correspondence revealed that R1 had two call buttons to return to the facility. S2 indicated that R1’s bed is on the same wall as the pull cord. CCLD Staff observed pull cords near residents’ bed and in the bathroom. Six out of six staff interviews indicated they do not remove residents’ pendants. Five out of nine resident interviews indicated that staff have not removed their pendants. Four out of nine residents said they do not have a pendant. Regarding the allegation “Staff did not provide resident with a call button," based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation: Regarding the allegation "Staff did not ensure that resident was hydrated,” it is being alleged Resident #1 (R1) had to go to the hospital due to dehydration because staff did not ensure R1 remained hydrated. Preplacement and Service Plan revealed R1 does not require assistance with meal consumption as of June 2024. Six out of six staff interviews indicated they encourage residents to stay hydrated and they provide water. Record review revealed that UTI and Hydration In-Service training was provided to staff on 06/27/24. Urinary Tract Infection (UTI) In-Service training was provided to staff on 08/14/24. Four out of nine resident interviews indicated staff does not ensure they drink plenty of water. Four out of nine residents indicated staff does ensure they drink plenty of water. One out of nine residents indicated water is offered at mealtimes. Interview with the Health and Wellness Director (S2) indicated hydration is encouraged to all residents and R1; especially when R1 receives new medication. Interview with S2 indicated residents also have pitchers or water bottles in their rooms. CDSS staff observed water stations in the bistro room, the dining room, and bottled water in residents’ room. Continue to LIC9099-C. Regarding the allegation Staff did not ensure that resident was hydrated,” based on record reviews, interviews, and observations the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation: Regarding the allegation "Staff did not provide responsible party with a refund,” it is being alleged staff has not refunded $932.00 prorated rent (10/28/24 – 10/31/24). Resident #1’s (R1) Admission Agreement revealed that “you may terminate this Agreement at any time, with or without cause, by giving the Executive Director thirty (30) days’ prior written notice of termination. You will continue to be responsible for your full Monthly Fee until the thirty (30) day period has expired”. Interview with the Executive Director (S1) indicated that R1 is responsible for giving a 30-day notice and notice was given on 10/25/24. Therefore, S1 said the billing extends to November 25, 2024, R1 would not receive a refund, and R1 would be responsible for the remaining balance. S1 indicated that the balance can be waived in good-faith. Regarding the allegation “Staff did not provide responsible party with a refund," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. An exit interview was conducted and a copy of this report was provided to the Health and Wellness Director Tamera Gant.the state’s words, verbatim · CDSS document, Nov 14, 2024 · control 11-AS-20241108095743

Allegation investigated: Staff did not provide resident with a call button. Staff did not ensure that resident was hydrated. Staff did not provide responsible party with a refund.

The investigation consisted of the following: On 11/14/2024, Community Care Licensing Division (CCLD) Staff conducted a complaint investigation at the above facility to address the following allegations. CCLD Staff met with Health and Wellness Director Tamera Gant and explained the purpose of the visit. CCLD Staff conducted resident and staff interviews, toured the facility, and reviewed resident and facility records. Allegation: Regarding the allegation "Staff did not provide resident with a call button,” it is being alleged during the night shift, staff would take Resident #1’s (R1) personal call button because R1 called staff too much. Record review revealed that R1 slipped and fell on 10/12/24 9:15 AM while trying to get R1’s pendant. The incident report revealed R1 said the caregiver took R1’s pendant and placed it on R1’s desk. Continue to LIC9099-C. Unsubstantiated Interview with the Health and Wellness Director (S2) indicated that R1’s pendant was removed because R1 said it was chocking R1 at night. Thus, S2 said the caregiver tied the pendant to the bedrail. S2 said R1 thought the pendant was on the end desk and R1 attempted to retrieve it resulting in a fall. S2 indicated that R1 was given a wrist pendant in response to the incident and at the request of the R1’s family. October 31, 2024 email correspondence revealed that R1 had two call buttons to return to the facility. S2 indicated that R1’s bed is on the same wall as the pull cord. CCLD Staff observed pull cords near residents’ bed and in the bathroom. Six out of six staff interviews indicated they do not remove residents’ pendants. Five out of nine resident interviews indicated that staff have not removed their pendants. Four out of nine residents said they do not have a pendant. Regarding the allegation “Staff did not provide resident with a call button," based on record reviews, interviews, and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation: Regarding the allegation "Staff did not ensure that resident was hydrated,” it is being alleged Resident #1 (R1) had to go to the hospital due to dehydration because staff did not ensure R1 remained hydrated. Preplacement and Service Plan revealed R1 does not require assistance with meal consumption as of June 2024. Six out of six staff interviews indicated they encourage residents to stay hydrated and they provide water. Record review revealed that UTI and Hydration In-Service training was provided to staff on 06/27/24. Urinary Tract Infection (UTI) In-Service training was provided to staff on 08/14/24. Four out of nine resident interviews indicated staff does not ensure they drink plenty of water. Four out of nine residents indicated staff does ensure they drink plenty of water. One out of nine residents indicated water is offered at mealtimes. Interview with the Health and Wellness Director (S2) indicated hydration is encouraged to all residents and R1; especially when R1 receives new medication. Interview with S2 indicated residents also have pitchers or water bottles in their rooms. CDSS staff observed water stations in the bistro room, the dining room, and bottled water in residents’ room. Continue to LIC9099-C. Regarding the allegation Staff did not ensure that resident was hydrated,” based on record reviews, interviews, and observations the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. Allegation: Regarding the allegation "Staff did not provide responsible party with a refund,” it is being alleged staff has not refunded $932.00 prorated rent (10/28/24 – 10/31/24). Resident #1’s (R1) Admission Agreement revealed that “you may terminate this Agreement at any time, with or without cause, by giving the Executive Director thirty (30) days’ prior written notice of termination. You will continue to be responsible for your full Monthly Fee until the thirty (30) day period has expired”. Interview with the Executive Director (S1) indicated that R1 is responsible for giving a 30-day notice and notice was given on 10/25/24. Therefore, S1 said the billing extends to November 25, 2024, R1 would not receive a refund, and R1 would be responsible for the remaining balance. S1 indicated that the balance can be waived in good-faith. Regarding the allegation “Staff did not provide responsible party with a refund," based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiency was cited for this allegation. An exit interview was conducted and a copy of this report was provided to the Health and Wellness Director Tamera Gant.the state’s words, verbatim · CDSS document, Nov 14, 2024 · control 11-AS-20241108095743

Allegation investigated: Staff did not prevent resident from choking another resident.

On 10/30/2024, the department conducted a complaint investigation at the above facility to address the following allegation. The department met with Health Wellness Nurse Director Tamera Gant and explained the purpose of the visit. The department conducted interviews, reviewed resident records, and requested copies of supporting documents. The investigation consisted of the following: The department interviews five staff members 1- 5(S1-S5) and six residents 1-6 (R1-R6). The department asked questions relevant to the nature of the complaint. During the course of the investigation, the department toured the first floor of the facility building to check for health and safety threats of residents. The department requested the following supporting documents for two residents (R1-R2) including Physician’s report, medical records, admission agreement, identification and emergency information, medication log, medication administration records (MARs) medical assessment, consent form, and appraisal/needs and services plan. Unsubstantiated Allegation: Staff did not prevent resident from choking another resident. Regarding the allegation "Staff did not prevent resident from choking another resident" it is being alleged that the roommate of a resident choked the other resident while sharing the same room. On 10/30/2024, five out of five staff (S1-S5) interviews indicated that the choking incident never happened and when a resident complains about a roommate, they make sure to talk with other roommate about the concern. Interview with the Health Wellness Nurse Director indicated that on 10/21/24 9:47 PM, the facility was contacted by a resident’s family member about the incident through emails. On 10/22/24 10:51 AM, the facility and family member worked on a solution to the problem. The Health Wellness Nurse Director indicated that rooms are constantly monitored in the middle of the night and the Health Wellness Nurse Director observed a resident say someone was trying to chock him/her. When they checked resident was a sleep. On 10/22/24, 1:48 PM, the facility removed Resident #2 (R2) from resident #1 (R1’s) room. five out six residents (R1-R6), interviews indicated that when there is a resident-on-resident altercation, staff are fast to assist and resolved the issue. One out six resident interviews indicated that the facility needs to stop residents form yelling at one another in the exercise room, though the trainer resolves the issue quickly. Based on the interviews, records reviewed there was not enough sufficient of 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 unsubstantiated. There were no deficiencies cited. Exit interview conducted. A copy of the report was provided.the state’s words, verbatim · CDSS document, Oct 30, 2024 · control 11-AS-20241022090726

Allegation investigated: Facility is prohibiting resident from receiving private care of their own choosing. Facility did not report an incident involving resident as necessary.

On 06/19/24, Licensing Program Analyst (LPA) Elvira Gonzalez conducted an unannounced subsequent complaint visit at this facility. LPA Gonzalez met with Tamara Gant, Health and Wellness Director, and the purpose of today's visit was explained. The investigation consisted of the following: On 05/08/24, LPA Gonzalez obtained a copy of the Resident Roster, Staff Roster, Physician’s Reports, Admission Agreement, Preplacement Appraisal Information, and Care Plan, interviewed staff #1- staff #4 (S1-S5), and attempted to interview Witness #1 (W1). On 06/19/24 LPA obtained the Resident Roster, interviewed residents #1-#9 (R1-R9), and attempted to interview W1. Investigation revealed the following: Continued on LIC809-C Unsubstantiated Allegation: Facility is prohibiting resident from receiving private care of their own choosing. It is alleged that a private care representative was denied access to facility residents. On 05/08/24, LPA interviewed Tamera Gant, Health, and Wellness Director. Interview revealed that there had been two incidents with an Occupational Therapist who was rude and confrontational towards her. She then had to call the Occupational Therapist’s boss and advised them of their behavior and the confrontation, and that they were no longer allowed in the facility. On 05/08/24 LPA Gonzalez interviewed S1-S5. LPA asked staff if they had witnessed an altercation between the Health and Wellness Director and an Occupational Therapist. 3 out of 5 staff stated that they had not witnessed any altercation. LPA asked staff if they prohibit residents from receiving private care of their own choosing. 5 out 5 staff reported the facility does not prohibit residents from getting treatment from someone of their own choosing. Furthermore, LPA called and attempted to speak with Paul Kim (Occupational Therapists boss) on 05/08/24 and on 06/19/24 but was not able to establish contact. On 06/19/24 LPA interviewed R1-R9. LPA asked residents if they are allowed to choose their own private care. 8 out 9 residents interviewed reported that they are allowed to choose their own private care. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be UNSUBSTANTIATED. Allegation: Facility did not report an incident involving resident as necessary. It is alleged that the facility is not reporting incidents as required when the residents fall or get injured. On 05/08/24, LPA interviewed Tamera Gant, Health, and Wellness Director. Interview revealed that there was no evidence of a fall or an injury for R1 during the dates of 04/17/24 – 04/24/24. She stated that resident did have a scratch above her eye due to the residents’ long nails, which staff cleaned and put a band aid over the scratch. No incident report was made due to it being a small surface scratch. On 05/08/24 LPA Gonzalez interviewed S1-S5. LPA asked staff do they report an incident when a resident falls or gets hurt. 5 out of 5 staff stated that the facility reports all incidents including falls and or injuries when needed. On 06/19/24 LPA Gonzalez interviewed R1-R9. LPA asked residents what the procedure is when residents fall or get hurt. 5 out of 9 residents stated that they pull on their call button string, and staff arrive shortly after. 9 out of 9 residents stated that they are satisfied with the facility and the services being provided to them. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of the report was given to Tamera Gant, Health and Wellness Director.the state’s words, verbatim · CDSS document, Jun 19, 2024 · control 11-AS-20240501111302

Allegation investigated: Resident's invoice statement is not correct Staff would not give an itemized invoice to resident Staff threatened resident with eviction

On 04/04/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a subsequent complaint visit to the facility listed above. During today’s visit LPA met with Health and Wellness Director, Tamera Grant, and the purpose of today’s visit was explained. We were later joined by Executive Director, EJ Lewis. During todays visit LPA toured the facility, interviewed Staff (S2-S8), and interviewed Residents (R7-R11). During a previous visit on 10/25/23, LPA toured the facility, interviewed staff (S1), interviewed residents (R1-R6), and received documents pertinent to the investigation. The documents include a Staff Roster, Resident Roster, Admission Agreement, Billing Statements, Itemized Billing, Needs and Service Plans, and Pre-Appraisal. The investigation revealed the following: Unsubstantiated Allegation: Resident's invoice statement is not correct The allegation alleges that a resident pays their rent every month even when the rent goes up, and they are unsure how they owe a certain amount. During record review, LPA received and reviewed R1’s Resident Detail (Summary) Ledger from July 2021 through November 2023. LPA observed a charge of $72 in March 2023 and a charge of $156 in April 2023 for room service. On the Ledger, LPA observed the charge was rolled over every month there after as an unpaid balance. During an interview with resident R1, LPA asked if they were informed of what the additional charge was for, they stated some months back they were informed by management their meals would be delivered to their room. R1 stated they were not informed of the reason it was going to be delivered when R1 usually would go to the kitchen at 3:30pm and get both lunch and dinner and would take it back to their room. R1 stated they did not agree to being charged for the tray delivery service and accepted the service per their request. Additionally in the interview R1 stated they met with the new administrator on 10/18/34 regarding the charge and told them they were not going to pay for something they did not request. R1 stated the issue was resolved and they removed the charges on 10/18/23. During interviews with Residents R1-R11, LPA asked if they had any issues with their monthly billing statement, nine (9) out of eleven (11), stated they have had no issues with their monthly billing statement. During an interview with S1, LPA asked if they knew the reason why R1 was provided with tray service, S1 stated they did not know the reason why R1 was provided with tray service due to S1 was not working at the facility during that time. During interviews with Staff S1-S8, were asked what monthly rate residents are charged, eight (8) out of eight (8) Continued on LIC9099-C stated they are charged based on single or double occupancy room and the level of care they require and are provided with. During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated. Allegation: Staff would not give an itemized invoice to resident The allegation alleges that the resident requested an itemized invoice of services and charges showing where the additional charge is from, and the facility is not providing the information. During resident file review, LPA received and reviewed a copy of R1’s itemized billing statement. S1 reviewed the invoice with LPA and broke down the charges. During an interview with Staff S1-S8, LPA asked if residents are provided with an itemized billing statement if they request it, eight (8) out of eight (8) stated if a resident or responsible party request an itemized receipt they are provided with a copy. Additionally, S1 stated they invite residents and the responsible party to come by their office and they will break it down and review each charge with them. During interviews with Resident R1-R11, LPA asked if they receive an itemized billing statement when requested, eight (8) out of eleven (11) stated they have had no issues with receiving an itemized billing statement. Additionally, R1 stated they did eventually receive an itemized billing statement and the Executive Director reviewed it with them and they were able to discuss the charges in question. During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, Continued on LIC9099-C there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated. Allegation: Staff threatened resident with eviction The allegation alleges that facility staff threatened to evict resident if they do not pay the amount owed. During document review, LPA received and reviewed all eviction notices given to residents in the past 3 months. LPA observed all eviction notices reviewed met Title 22 regulations and Community Care Licensing had received notices of these evictions. During an interview with Resident R1-R11, LPA asked if they have received an eviction notice or have been threatened with eviction if they do not pay full amount due, ten (10) out of eleven (11) stated they have not received an eviction notice or been threatened with eviction and if you do owe a balance the facility is willing to work with you to get it paid. During an interview with R1 they stated they were told by S1 that if the unpaid balance is not brought up to date could be grounds for evection. During an interview with S1, they stated they informed R1 of the amount due with a letter asking to bring the account up to date and if they are not able to then meet with S1 and see what they could do. S1 stated they reviewed the charges with R1 and informed them if it is not brought up to date it could be grounds for evection as specified in R1s Admission Agreement. LPA received and reviewed a copy of R1s Admission Agreement, that stated on page 4 “The facility may, upon thirty (30) days’ written notice to the resident, terminate this agreement for any of the following reasons: 1. For nonpayment of monthly rate with ten (10) days after due date.” Continued on LIC9099-C During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated. LPA did not observe or cite any deficiencies during today’s visit. An exit interview was conducted with Executive Director, EJ Lewis and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 4, 2024 · control 11-AS-20231018150058

Type of visit: Required - 1 Year

On 03/14/2024, Licensing Program Analyst (LPA) Sparkle Day conducted an unannounced annual required visit with the CARE Inspection Tool. LPA met with Executive Director E. J. Lewis and explained the purpose of today’s visit. The facility is licensed to operate for one hundred and seventy-five (175) elderly residents ages 60 and above of which five (5) can be bedridden on the first floor and 74 non-ambulatory. The facility is approved for five (5) hospice. Currently there are 86 residents in facility. LPA reviewed 8 resident files and 5 staff files. LPA interviewed staff and residents during this visit. The facility is two stories with no memory care. There is a total of 37 resident rooms on the first floor and 57 rooms on the second floor. There is a parking area in the front and side of the facility. The lobby/receptionist area is located as you enter the building. There are two common bathrooms on each floor. The activity room is located on the first floor. The dining room is located on the first floor. The TV/Movie room are located on the first floor. The staff break room is located on the first floor. The library is located on the second floor with a computer accessible for residents. There an outside patio area with canopies and tables with chairs all along the perimeter. The salon and physical therapy room is located on the second floor. LPA and Executive Director toured the physical plant. There were no bodies of water or obstructions on the premises. Various rooms were inspected – rooms 133, 139, 141, 206, 212, 229, 231, 235, and 237, where beds and bedding supplies were in good condition, adequate lighting provided, storage for resident personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit. Bathrooms were found to be within Title 22 regulations and were clean and operational. Water temperature was measured and within Title 22 regulations between 110 F and 105 F. A comfortable temperature was maintained in the facility. LPA observed the facility to be sanitary and appropriately furnished at the time of visit. The kitchen was inspected and there is sufficient perishable and non-perishable food available and maintained properly. There is a walk in refrigerator and freezer fully stocked in the kitchen. Food deliveries are made to the facility every Tuesday and Thursday of every week. Multiple fire extinguishers were fully charged on each floor. Medication room is located on the second floor for the facility and was inspected. Laundry rooms exist on each floor. . Fire drills are conducted monthly. All mandated inspection control posters were posted. No deficiencies were cited during this inspection visit. An exit interview was conducted and a copy of this report was provided to E.J. Lewis.the state’s words, verbatim · CDSS document, Mar 14, 2024

Allegation investigated: Staff does not safeguard resident's personal items. Staff did not address resident's abusive behavior. Staff does not prevent resident from hoarding various items. Staff does not keep the facility free of roaches.

On 03/07/24, at 09:00am, Licensing Program Analyst (LPA) Perry Scott conducted a subsequent unannounced visit to the facility and was greeted by Ernesto Lewis, Administrator. LPA explained the purpose of this visit is to gather additional information and deliver findings for the allegations mentioned above. The investigation consisted of the following: An initial complaint visit was completed by LPA Jeremiah Randle on 11/18/22. A subsequent visit was completed by LPA Perry Scott on 03/07/24. LPAs investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R10). Client Roster, Staff Roster, Admissions Agreement, and Pest control invoices were obtained from the facility. The investigation revealed the following: Allegation #1- Staff does not safeguard resident's personal items. Report continued on LIC9099-C Substantiated The details of the complaint alleged that the facility staff does not safeguard residents’ personal items because another resident is stealing from them. On 03/07/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S4) and residents (R1-R10) regarding the allegation. 3 of 4 staff confirmed the allegation that Staff does not safeguard resident's personal items. The majority of the staff interviewed stated that there is an issue with one of the residents stealing from other residents. S1 stated that the resident involved in the ongoing theft has been counseled on the issue repeatedly and ultimately the facility had to issue an eviction notice to the resident. LPA interviewed R1-R10 about the allegation that Staff does not safeguard resident's personal items. 7 of 10 residents confirmed the allegation and stated that there is theft in the facility. Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation: Staff does not safeguard resident's personal items, are found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) are being cited on the attached LIC 9099D. Deficiencies are issued and plans of corrections were discussed. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. * Allegation # 2- Staff did not address resident's abusive behavior. The details of the complaint alleged that one of the residents at the facility has abusive behavior toward other residents and the facility does not address that behavior. On 03/07/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S4) and residents (R1-R10) regarding the allegation. 3 of 4 staff confirmed the of allegation that Staff did not address resident's abusive behavior. The majority of the staff interviewed stated that there has been a problem with abusive behavior from one of the residents toward other residents in the facility. LPA interviewed R1-R10 about the allegation that Staff did not address resident's abusive behavior. 7 of 10 residents confirmed the allegation and stated that a resident in the facility has been abusive verbally and physically towards them and others at one time or another. Based on interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation: Staff did not address resident's abusive behavior, are found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) are being cited on the attached LIC 9099D. Report continued on LIC9099-C Deficiencies are issued and plans of corrections were discussed. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. * Allegation # 3- Staff does not prevent resident from hoarding various items. The details of the complaint alleged that the facility is not preventing the resident from participating in hoarding tendencies. On 03/07/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S4) and residents (R1-R10) regarding the allegation. 4 of 4 staff confirmed the allegation that Staff does not prevent resident from hoarding various items. All staff interviewed stated that there is an issue with one of the residents’ hoarding items in their room. Staff stated that they must go in the room weekly and check that it isn’t getting to crowded with items and take those items that are not needed and dispose of them. LPA interviewed R1-R10 about the allegation that Staff does not prevent resident from hoarding various items. 7 of 10 residents confirmed the allegation and stated that there is a resident who hoards items in their room and the staff and housekeeping had to go in to clear the room out. Based on interviews conducted, the preponderance of evidence standard has been met. Therefore, the above allegation: Staff does not prevent resident from hoarding various items, are found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) are being cited on the attached LIC 9099D. Deficiencies are issued and plans of corrections were discussed. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. * Allegation # 4- Staff does not keep the facility free of roaches. The details of the complaint alleged that the facility has roaches because of a resident’s hoarding tendencies, which the facility does not address. On 03/07/24, from 09:00am-02:00pm, LPA interviewed staff (S1-S4) and residents (R1-R10) regarding the allegation. 2 of 4 staff confirmed the allegation that Staff does not keep the facility free of roaches. Half of the staff interviewed stated that they have seen roaches, but the facility does have a pest control company that comes out every two weeks to spray for pests. LPA interviewed R1-R10 about the allegation that Staff does not keep the facility free of roaches. 8 of 10 residents confirmed the allegation and stated the facility has a problem with roaches. LPA reviewed the pest control plan and service is being conducted bi-monthly to control the problem. Report continued on LIC9099-C Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation: Staff does not keep the facility free of roaches, are found to be Substantiated. California Code of Regulations, Title 22, Division (6) and chapter (8) are being cited on the attached LIC 9099D. Deficiencies are issued and plans of corrections were discussed. Note: *Citations not cleared by the due date will be a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. * An exit interview was conducted with Guadalupe Delgado, Leave Concierge. Plans of corrections were discussed, and a copy of this report and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 8, 2024 · control 11-AS-20221114111732

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87217(b) · Plan of correction due date: Mar 14, 2024

87217(b) Safeguards for Resident Cash, Personal Property, and Valuables. Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff…This requirement was not met as evidenced by: Based on interviews, the administrator did not comply with this section. The facility failed to properly safeguard residents’ personal property because another resident in the facility was stealing their items, which poses a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Mar 8, 2024

Plan of correction: The administrator will develop a plan of correction on how to prevent future incidents of theft of resident's property and hold in-service training relating to theft in the facility. The licensee will submit proof of plan of correction and in-service training of staff by POC due date of 3/14/24. Submit proof to LPA Scott’s email at perry.scott@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Mar 14, 2024

87468.1(a)(3) Personal Rights of Residents in All Facilities(a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination. This requirement is not met as evidenced by: Based on interviews of staff and residents, the licensee failed to ensure a resident's personal rights due to a residents abusive and harassing behavior towards other residents, which poses a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Mar 8, 2024

Plan of correction: The administrator will ensure that all residents are accorded dignity in their personal relationships with staff, residents, and other persons. Facility to conduct in-service training on providing supervision appropriately to keep residents safe from abusive behavior from other residents and submit signed log of those who attended and email it to perry.scott@dss.ca.gov by POC due date of 03/14/24.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(2) · Plan of correction due date: Mar 14, 2024

Personal Rights of Residents in All Facilities (a)Residents in all residential care facilities for the elderly shall have all the following personal rights: (2) To be accorded safe, healthful, and comfortable accommodations... This requirement is not met as evidenced by: Based on interviews and records reviewed the facility failed to provide a safe and healthful environment for resident by allowing another resident to hoard food, boxes, and empty bottles in their room, which poses a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Mar 8, 2024

Plan of correction: The administrator will have in-service training with staff and housekeeping and develop a plan of action to combat this type of behavior in residents. The administrator will submit proof of plan of correction and in-service training of staff by POC due date of 3/14/24, to LPA at perry.scott@dss.ca.gov .

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Mar 14, 2024

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidence by: Based on documentation and interviews, the facility had roaches. LPA reviewed pest control invoices and observed that the facility had an ongoing issue with roaches in the month of October 2022 that were being treated by Dewey Pest Control bi-monthly to eradicate and control future infestations, which poses a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Mar 8, 2024

Plan of correction: Corrected during visit. Administrator provided invoices for pest control visits dated: October-December of 2022 and recent reports on a bi-monthly schedule for prevention. Administrator shall continue to use the services of a pest control company to ensure the health and safety of the residents and staff.

Allegation investigated: Facility staff mismanaged residents' medications

On 3/7/24 Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced complaint visit to the address listed above. LPA arrived and spoke to Executive Director, Ernest (EJ) Lewis and the purpose of the visit was discussed. LPA was granted access to the facility. The investigation consisted of the following: A review of the facility's roster for residents and staff. Interviews with residents -1 through residents - 9 (R-1 - R-9), and staff -1 through staff – 6 (S-1 – S-6). A review of resident files, MARs logs, incident reports for last 6 months and any records associated with this complaint was conducted. A tour of the facility was performed. The investigation revealed the following: Con’d on 9099-C Substantiated Allegation : Facility staff mismanaged residents' medications. It is alleged that residents have missed medications and that some have not had their prescriptions filled. On 12/14/2023 LPA Shirley reviewed facility records. LPA received copy of eMAR for resident 1 – resident 4 (R1-R4). LPA Shirley noted that most R1, R2 and R3 missed several days of medications. LPA requested and received incident reports from the last 6 months. Upon record review, LPA did not observe any report notifying CCLD of the pharmacy switch and issues dispensing medications. On 12/14/2023 LPA Shirley spoke to facility Administrator Ernest Lewis regarding the allegations. During interview administrator stated facility implemented a new system for dispensing medications as the facility had a change in pharmacy. Administrator further stated that several of the med techs could not access the new program, so there was a manual medication log being used. LPA Shirley requested copies of the facilities manual log. On 12/19/2023 LPA Shirley called to follow-up on the manual mediation logs and was told by Administrator Ernest Lewis that he could not obtain logs. As of 3/7/2024, no copies of the manual logs have been provided. LPA interviewed Staff 1 to Staff 6 (S1-S6). LPA asked staff if there is a history of missed medications at the facility. Of those interviewed, 4 out of 6 indicated there is no history. LPA interviewed resident 1 to resident 9, (R1 to R9), R10 was not available. LPA ask residents, “Have you ever missed getting your medication?” Of those interviewed, 5 out of 9 had no issues. Con'd on 9099-C Deficiencies are being cited based on LPA observations and interviews conducted in accordance with the California Code of Regulations, Title 22, Divisions 6 chapter 1, see LIC 9099-D. An exit interview was conducted, Plans of Corrections were discussed and a copy of this report and appeals rights were and left with Director Ernest (EJ) Lewis whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, Mar 7, 2024 · control 11-AS-20231207091941

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(6) · Plan of correction due date: Mar 7, 2024

87465 Incidental Medical and Dental Care 6) When requested by the prescribing physician or the Department, a record of dosages of medications which are centrally stored shall be maintained by the facility. This requirement was not met as evidenced by: Based on interviews and records reviews, the facility staff failed to make accurate records for prescribed medications for (R3). This violation poses a potential health, safety, or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Mar 7, 2024

Plan of correction: Licensee will submit plan informing the department medication training has been peformed with all staff. A written proof of correction must included date, time and particpants names. Correction must be submitted by due date: 03/21/24 to LPA's email: felisa.shirley@dss.ca.gov

Allegation investigated: Staff do not respond to resident requests for assistance in a timely manner.

On 01/06/24, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent complaint visit to this facility. LPA was greeted by the Resident LIfestyle Director Danilo Aguilan. LPA contacted executive director EJ Lewis by telephone and explained the purpose of the visit is to deliver findings for the allegation mentioned above. The investigation consisted of the following: A review of the facility's roster for residents and staff. Interviews with residents #1-#10 (R1-R10), staff #1-#4. A review of resident #1 (R1's) service records. and resident Monitoring Shift Logs and other pertinent records associated with this complaint was conducted. A tour of the facility was performed on 11/30/23. (Evaluation Report continues LIC 9099-C) Unsubstantiated On 12/11/23 between 12:13 pm and 2:30 pm (4) out of (7) staff #5 - #11 care staff for (R1) denied the allegation. (S5-S8) did not acknowledge the incident involving (R1) and denied having a resident not assisted for over an hour. (S5-S8) stated not having any issues with (R1) and is being assisted accordingly every two hours or as needed. (S5-S8) verified the staff maintained a daily monitoring log for residents requiring assistance. (S5-S8) reported when the call button is activated the residents are assisted timely within minutes and not an hour. (S5-S8) does not recall (R1) having a fall incident in November 2023. (S9-S11) were not available for an interview on 11/30/23 and 12/11/23. On 11/30/23 through 01/06/24, the Department reviewed monitoring logs for each shift for the month of November 2023 and it revealed that (R1) was being monitored and assisted with (ADL) every two hours. (R1) did not have any family representatives as listed to be contacted for statements. Based on the information gathered, there is not enough evidence to corroborate the allegation. Based on the information provider, an inspection of the facility, observation, interviews, and analysis of records, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated. No deficiencies were identified during this visit. An exit interview was conducted with Danilo Aguilan, and a copy of the report was provided. INVESTIGATION REVEALED THE FOLLOWING: Allegation #3: Staff do not respond to resident requests for assistance in a timely manner. The details of the complaint alleged the staff does not respond to residents for assistance on time. The complainant specifically referred to resident #1 (R1) who had fallen off the bed and was on the ground floor after activating the call button for assistance. The complainant reported staff did not assist (R1) for over an hour. The complainant was not forthcoming with further details on the incident with the date, time, or the staff members involved. On 11/30/23 between 11:30 am and 12:45 pm (9) out of (10) residents #2- #10 (R2-R10) stated they were assisted in a timely manner. Nine out of ten residents stated they have had no issues or concerns with incontinent care and in some cases do not require assistance with daily activities. An interview with (R1) recalled an incident when no staff member was available to assist after activating the call button in the bathroom for over an hour and sitting in the toilet during that time. (R1) could not recall the date, the time, and the two staff members’ names that were involved. (R1) stated it was an isolated incident and it may have been a week or two ago, otherwise, the staff does respond timely when called within (5) to 10 minutes. (R1) claimed not to have had a fall incident recently or in the past. The Department tested (R1’s) call button on 11/30/23 and observed the equipment to be operable. On 11/30/23 between 10:20 am and 11:20 am (2) out of (2) staff #1 and #4 (S1 and S4) stated residents are monitored every two hours for each shift or as needed when the call button is activated. (S1 and S4) stated for every shift the residents that require assistance and are not independent are being monitored every two hours during each shift and the facility maintains a daily monitoring log for each resident for each shift. (S1 and S4) did not acknowledge the incident involving (R1) and denied having a resident not assisted for over an hour. (S1 and S4) reported even in the busiest time, a resident is assisted within 10 minutes. The front desk is alerted when a resident activates the call button and alerts the front desk to dispatch a care staff immediately. (S1 and S4) does not recall (R1) having a fall incident in November 2023. (Evaluation Report continues LIC 9099-C)the state’s words, verbatim · CDSS document, Jan 6, 2024 · control 11-AS-20231128151552

Allegation investigated: Staff did not ensure resident's bandages were being changed.

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Thursday, January 04, 2024, Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Executive Director Ernest Lewis. LPA Bunker explained the purpose of today's visit. The investigation consisted of the following: Interviews with staff members 1-2 (S1-S2) and residents 1-8 (R1-R8). According to the statements from S1-S2, there were no instances where staff did not ensure resident's bandages were not being changed. LPA Bunker thoroughly reviewed R1's records and requested copies of relevant supporting documents for a detailed analysis. It was clarified by S1-S2 that the decision to change the resident's bandage indicated that the facility had no direct control over the wound. S1-S2 stated the facility is providing supporting care and supervision needed to meet the needs of the resident receiving home health care. S1-S2 stated Resident 1 is receiving care for the pressure injury from the physician and appropriate skilled professional. See continued LIC9099-C page 2 Unsubstantiated Continued LIC812-C page 2 Allegation: Staff did not ensure resident's bandages were being changed. In response to this, allegation interviews were conducted with both staff members 1-2 (S1-S2) and residents 2-8 (R2-R8). The collective feedback from these interviews unanimously indicated no issues concerning bandages not being changed. Resident 1 (R1) stated the issue with changing the bandage on the left leg was resolved. S1 stated if a resident has a stage one or two pressure injury condition it is diagnosed by a physician or an appropriately skilled professional. S1-S2 stated all aspects of care performed by the medical professional and facility staff are documented in the resident's file. Residents 1-8 (R1-R8) expressed their satisfaction with living at the facility, highlighting the respect, dignity, and quality of care they receive. They also commended the facility for providing a secure, healthful, and comfortable living environment and they were happy. S1-S2 refuted the allegation, reinforcing the commitment to safety and well-being upheld at the facility. Investigation revealed the following: During interviews, staff members S1-S2 they emphasized that the wound care needs of resident 1 are being meticulously addressed by a UCLA wound care clinic. They elaborated that for certain residents, Home Health Agencies are engaged to administer bandage changes and specialized dressing services on-site. It was categorically stated by S1-S2 that the facility’s nurse is not involved in direct wound care services but plays a supportive role. S1-S2 and the facility nurse have conducted thorough briefings with all residents regarding the wound care procedures. Addressing specific concerns, S1-S2 assured that no resident is expected to self-administer wound care. They emphasized the facility’s commitment to providing essential support and supervision, particularly for residents receiving home health care services. For residents with stage one or two pressure injuries, diagnosis, and care are exclusively managed by physicians or qualified professionals, with all care procedures meticulously documented in the resident's files. Residents R1-R8 have affirmed the adequacy of care and supervision provided by the staff. S1-S2 reiterated their comprehensive understanding and adherence to Title 22 Regulations regarding wound care procedures, firmly denying any allegations suggesting non-compliance or negligence. This collective testimony from S1-S2 and R2-R8 robustly refutes the allegation in question. 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 Administrator. There were no deficiencies cited. Exit interview conducted.the state’s words, verbatim · CDSS document, Jan 4, 2024 · control 11-AS-20231226112219

Allegation investigated: Staff did not respond to resident’s call in a timely manner. Staff does not ensure water temperature was appropriate for residents Facility dishwasher is in disrepair.

On 12/20/2023 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Ernesto Lewis/Administrator. LPA explained the purpose of this visit. Investigation Consited on the following: Administrator’s Interview (A#1), Resident interviews (R#1-R#9), Staff interviews (S#1-S#9), a tour of the facility including 10 residents’ rooms bathrooms and kitchen. LPA obtained and reviewed the following documents: Resident’s Roster, Personnel Roster, (R#1-R#9) Identification and Emergency Information, (R#1-R#9) Admissions agreements, (R#1-R#9) Physicians Report for Residential Care Facilities for the Elderly, (R#1-R#9) Needs and Services Plan, (R#1-R#9) Medication Administration Record (MAR) for the month of December 2023 and copies of facility water temperature log. Evaluation Report continues LIC 9099-C Unsubstantiated Allegation: Staff did not respond to residents’ call in a timely manner. The details of the complaint alleged that facility staff are not responding in a timely manner to residents’ emergency calls. During an interview with the Administrator (A#1), he stated that an alarm signal goes to the call light panel when a resident pulls the cord from the bedroom. We have one in the receptionist area and one in the medication area. So, when the person sees the alarm on the system, they alert the care staff by walkie-talkie. In addition, (A#1) stated that attending the resident's call takes approximately 5 to 10 minutes. During interviews with residents (R#1-R#9), (2) out of (9) stated that they have never used the signal cord, but they think their staff will come immediately to assist them. Also, (5) out of (9) residents stated that they had used the cord, and most directly, the staff came and assisted them. Two (2) of the nine (9) residents have never used the emergency pull cord before. On the other hand, (1) out of (9) residents stated that it took the staff almost one hour to assist them. During interviews with staff (S#1-S#9), (9) out (9) stated that the facility's protocol when it comes to the residents using the signal system is the following: When the resident pulls the cord, it sends an alert to the front, where it shows on a monitor where it is coming. The receptionist sees the alert on it. She alerts the care staff that the resident needs assistance immediately. In addition, (8) out of (9) staff stated that it takes approximately 10 minutes to tend to the residents' calls and never an hour. On the other hand, (1) out of (9) staff stated that one time they heard that it took the staff one hour to tend to a resident's pull cord. Evaluation Report continues LIC 9099-C Allegation: Staff do not ensure the water temperature was appropriate for residents. The details of the complaint alleged that the water temperature is not appropriate for residents. During the review of the records, LPA observed the facility’s temperature log from January to December 2023. LPA observed that (7) residents’ rooms were chosen, and the maintenance person recorded the water temperature. The water temperature is between 105F°-120 F°. The water temperature never reached below 105 F°. or above 120 F°. During the facility tour, LPA Iniguez visited 9 residents’ bathrooms (127, 129, 134, 139, 142, 114, 259, 258, and 250). LPA measured the water temperature with his thermometer and observed that the temperature was between 105F°. to 120F°. It never reached below 105 F°. or above 120 F°. In addition, LPA observed the water pressure to be enough for the residents to use. During an Interview with the Administrator (A#1), he stated that there is hot water in the residents’ bathrooms and enough water pressure. During interviews with residents (R#1-R#9), (8) out of (9) stated that they had hot water in their bathrooms and the water pressure was good. On the other hand, (1) out of (9) residents stated that they lived in a shared room, but only two used the bathroom. During interviews with staff (S#1-S#9), (9) out (9) stated that the only ones sharing bathrooms are the shared rooms which are (6). In addition, (9) out of (9) said that there is hot water in the residents’ bathrooms and enough water pressure. Allegation: Facility dishwasher is in disrepair. The details of the complaint alleged that the facility dishwasher is in disrepair. During a facility tour, LPA Iniguez inspected the kitchen’s dishwasher. LPA asked one of the kitchen staff to start the dishwasher, and he observed that the machine was working correctly. During an Interview with the Administrator (A#1), he stated that the facility dishwasher is working correctly. During an Interview with (S#1), she stated that the facility’s dishwasher works appropriately. Evaluation Report continues LIC 9099-C During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations. Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted, and a copy of the Complaint Report was given to Ernesto Lewis /Administrator.the state’s words, verbatim · CDSS document, Dec 20, 2023 · control 11-AS-20231215133906

Allegation investigated: Licensee does not ensure faucets for personal care deliver adequate water for residents. Staff do not provide adequate food service to residents.

On 11/30/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted a complaint visit at this facility. LPA was greeted by the Marketing Director Rhonda Madrid. This inspection visit is to gather information for the allegation mentioned above and deliver findings. The investigation consisted of the following: A review of the facility's roster for residents and staff. Interviews with residents #1-#10 (R1-R10), staff #1-#4. A review of faciilty menu, service reports and other pertinent records associated with this complaint was conducted. A tour of the facility was performed. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Licensee does not ensure faucets for personal care deliver adequate water for residents. It is alleged the facility does not produce consistent water pressure or hot water for hand washing. The complainant reported the public restrooms do not have consistent pressure or hot water for hand washing. The complainant stated this is for the common restrooms often used by visitors or residents did not produce adequate water pressure or hot water temperature for personal care use. The complainant did not provide further details on the time or date of the incident. On 11/30/23 between 10:30 am and 10:40 am, the Department inspected all (4) public restrooms. The Department observed the public bathrooms were operational with hot water temperature measured at 107.4 - 109.9 degrees F. The public bathrooms had the normal water pressure between 45-80 psi. The restrooms were found to be within Title 22 regulations and were clean and operational. On 11/30/23 between 11:30 am and 12:45 pm (9) out of (9) residents had no issues with water pressure or hot water temperature when using private or public restrooms. Between 10:00 am - 10:50 am, staff #1 -#2 (S1-S2) confirmed that on 11/16/23 through 1/18/23, the facility's water was shut off due to leaky pipes in rooms #150 and #204. According to (S1-S2) the residents were given 24-hour written advance notice and announcement reminders through intercoms for the temporary shut-off maintenance repairs. (S1-S2) stated the work was done within 2 business days, and it was only 1.5 each day when the water was not operational. Based on the information gathered, the allegation mentioned above cannot be supported. Allegation #2: Staff do not provide adequate food service to residents. The details of the complaint alleged the food provided to residents was not served at a proper temperature. The complainant reported the food served is good, but fails to meet satisfactory temperature. The complainant did not provided further details regarding this matter. (Evaluation Report LIC 9099-C) The Department conducted an assessment between 11:45 and 12:45 pm and observed how meals were prepared and how meals were served. The Department noticed several hot food tray warmers, and food was carried out within two to three minutes at tables by (5) servers. The meals are “made to order" customized to specifications from the standard daily menu, weekly menu, or alternative menu. Interviews conducted with staff # 1 and #3 between 10 am and 11:20 am stated that residents have choices aside from what is on the daily/weekly menu and will be made upon request daily. In addition, residents have the right to refuse if they are not satisfied with the temperature; the dish will then be reheated/refrigerated or a new dish will be created. (S1-and S3) stated there is always an option for residents to refuse their meals and replace their meals to their liking if unsatisfied with what is being served. (According to S3), a resident may get preoccupied with socializing while their meals are being served, causing the food to cool for a few minutes. On 11/30/23, interviews between 11:30 and 12:45 pm (9) out of (9) residents #1-#9 (R1-R9) verified that they were aware of meal options and are aware that they do have the right to refuse meals served are substandard or not served in the proper temperature. (R1-R1) were complimentary of the food and service and had no issues with meals provided by the facility. The facility has a suggestion box available adjacent to the front office and dining room area to garner opinions or suggestions from residents, staff, or visitors. Based on information gathered, there is insufficient evidence to support allegation. Based on information gathered, through an inspection of the facility, observation, analysis records of service records, interviews, the Department found no evidence to support the allegations: "Licensee does not ensure faucets for personal care deliver adequate water for residents" and "Staff do not provide adequate food service to residents". Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations, did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted with Zoila Marroquin, and a copy of this report is provided.the state’s words, verbatim · CDSS document, Nov 30, 2023 · control 11-AS-20231128151552

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Allegation investigated: Facility is not following infection control protocols.

On 11/27/2023, Licensing Program Analyst (LPA) Antonine Richard conducted a 10-day complaint visit at this facility. LPA Richard conducted a risk assessment with Zoila Marroquin. The facility is free of Covid-19 infection. LPA met with Community Relations Director Rhonda Madrid S2. Administrator Lewis Ernest (S1) arrived shortly after and assisted LPA with the visit. LPA explained the purpose of the visit. The investigation consisted of the following: On 11/27/2023, LPA Antonine Richard toured the facility with Comunity Relations director Rhonda Madrid S2. LPA observed six (6) staff and six (6) residents during the visit. LPA reviewed records for staff and residents. LPA interviewed six (6) staff (S1-S6) and 6 residents (R1- R6). LPA Richard interviewed six (6) out of Thirty four (34) staff members, and inspection of apartments #131, #138, #157, #205, #213, #214, #227, #252, #241, Lounge, Screening, Dining, and A review of staff and resident rosters was conducted. REPORT CONTINUED IN LIC 9099C Unsubstantiated Investigations revealed: Allegation: Facility is not following infection control protocols. It is alleged that the reporting party stated facility is not following infection control protocols. During an unannounced facility visit, LPA Richard interviewed six (6) staff and six (6) residents Based on the department’s interview with the Administrator and staff (S1-S6) all denied the allegation. LPA interviewed three (3) full time caregivers (S3, S4 and S5) who provide direct care to residents stated wearing a mask while around with residents inside the resident’s room is a must, especially if the resident tested positive for Covid-19 in the last two weeks. The administrator stated we are following Covid-19 protocols. We care about our residents well being. We always tell our staff to check if a resident feels sick to assist them. LPA Interview with residents (R1-R6), all residents denied the allegation facility is not following infection control protocols. Residents stated that the staff always wearing masks when they enter their room. LPA observed S4 and S5 were wearing masks while working inside the resident room. Based on observation, interviews and record reviews, there is not sufficient of evidence to corroborate the above allegation. Based on interviews, and observation the Department did not find sufficient evidence to support allegation Although the allegation may have happened or are valid, there is not a preponderance of evidence the alleged allegation did or did not occur, therefore the above allegation facility is not following infection control protocols is found to be Unsubstantiated Exit interview was conducted A hard copy of the report was provided to administrator Lewis Ernest.the state’s words, verbatim · CDSS document, Nov 27, 2023 · control 11-AS-20231121125759

Allegation investigated: Staff did not address a change in resident's condition Staff did not ensure the resident was adequately fed Staff did not keep the resident's room clean & sanitary Staff left resident soiled in urine for an extended period of time Staff left resident's mattress on the floor Staff did not keep the facility free of flies

On 11/02/2023 at 8:07 am Licensing Program Analyst (LPA) David España conducted an initiated a 10-day complaint investigation subsequent visit for the allegation listed above. Upon arriving at the facility, LPA met with S#2 who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct inspections. The investigation consisted of the following: On 11/02/2023 at 8:19 am LPA España conducted a tour of facility plant; reviewed records for staff and residents and observations. LPA España conducted interviews with Ten (10) out of Eighty-nine (89) residents. LPA España interviewed Eight (8) out of Fifty-one (51) staff members. LPA España interviewed with two (2) out of 2 Witnesses. Contunied 9099-C Unsubstantiated Allegation: Staff did not address a change in resident's condition. The investigation revealed, per LPA España interviews, record reviews, and observations, with Ten (10) out of Eighty-nine (89) residents interviewed from Studio Royale, that the facility resident family members/responsible parties are notified of any changes to a resident’s health condition. S#1-S#10, informed the LPA that all changes to a resident’s health are documented in their resident file. S#1-S#10 also stated that S#1 makes sure that family members are notified, and the facility makes arrangement for medical appointments. In addition, S#1 and S#2 inform families of resident incidents that occur inside and outside of the facility. LPA observed based on interviews with S#1-S#10 that there has never been an issue with a resident’s family member not being notified of changes to a resident’s condition. S1 informed the LPA that R#4’s W#1 was notified of change of medical condition because of event on 10/16/23; 10/19/23; 10/07/23; 10/26/23; 10/19/23; 10/26/23; 10/27/23; 10/31/23; 10/19/23; via email. S#1 stated that the facility contacted R#4’s W1 and informed of R#4’s medical condition. R#4’s W1 did not inform that there were any concerns with R#4’s medical condition and what was noted is that W1 agreed to the conditions of R#4 having issues at the facility. In addition, the LPA interviewed Eight (8) out of Fifty-one (51) staff members who stated staff always documents and informs the resident’s family or responsible part of health care condition, or treatment. LPA interviewed two (2) out of 2 Witness and Witness #1 (W#1) stated staff always documents and informs the resident’s family or responsible part of health care condition, or treatment. LPA interviewed Witness #2 who disagreed with the level of care that was being provided to R#4. The LPA also interviewed Ten (10) out of Eighty-nine (89) residents who informed the LPA that the facility assists them with medical concerns and inform their family of any medical updates. Based on information gathered, LPA did not find sufficient evidence to support allegation: Staff did not address a change in resident's condition. Continued on 9099-C Allegation: Staff did not ensure the resident was adequately fed. LPA España interviewed Eight (8) out of Fifty-one (51) staff members who stated incontinent residents are checked during those periods of time when they are known to be incontinent and tray services are provided. LPA interviewed Eight (8) out of Fifty-one (51) staff members stated that incontinent residents are kept clean and dry, and that the facility remains free of odors from incontinence, and all are fed. LPA España interviewed Eight (8) out of Fifty-one (51) staff members and stated staff does receive ongoing training on managing residents' incontinence. LPA interviewed Eight (8) out of Fifty-one (51) staff members and stated residents are fed three meals a day plus snacks. LPA interviewed Ten (10) out of Eighty-nine (89) residents who stated residents are adequately fed and they are getting plenty of food to eat, three (3) meals per day plus snacks, breakfast, lunch, dinner, and snacks daily. LPA interviewed Ten (10) out of Eighty-nine (89) residents who stated the facility serves a well-balanced meal.LPA interviewed Ten (10) out of Eighty-nine (89) residents who stated the facility also provides alternative options, if residents does not want what is on the menu.LPA interviewed Ten (10) out of Eighty-nine (89) residents who stated the portions of food served are more than enough and they get plenty of food to eat and the staff will give them seconds. LPA interviewed Ten (10) out of Eighty-nine (89) residents who stated that they had no complaints about the food. All interviewed Ten (10) out of Eighty-nine (89) residents stated they are treated with dignity and respect, and the staff cares about them. LPA interviewed Ten (10) out of Eighty-nine (89) residents and stated that they are comfortable, the staff is providing the necessary care and supervision and their daily needs are being met. LPA interviewed Ten (10) out of Eighty-nine (89) residents and stated they were happy at the facility and had no problems, issues, or concerns. LPA noted that Eight (8) out of Fifty-one (51) staff members and Ten (10) out of Eighty-nine (89) residents who denied the allegations.Based on information gathered, LPA did not find sufficient evidence to support allegation: Staff did not ensure the resident was adequately fed. Continued on 9099-C Allegation: Staff did not keep the resident's room clean & sanitary. LPA interviewed Ten (10) out of Eighty-nine (89) residents and inspected ten (10) resident rooms and found that all ten (10) bedrooms were found to be in clean and sanitary condition. LPA interviewed Ten (10) out of Eighty-nine (89) residents who did not have any concerns with the allegation listed above. Eight (8) out of Fifty-one (51) staff members interviewed stated that housekeeping cleans resident bedrooms on a weekly basis and caregivers clean resident bedrooms while providing care to residents. Based on information gathered, LPA did not find sufficient evidence to support allegation: Staff did not keep the resident's room clean & sanitary. Allegation: Staff left resident soiled in urine for an extended period of time. The complainant alleges resident #4 (R#4's) mattress was soiled in urine and staff failed to assist with incontinence care. An interview with Ten (10) out of Eighty-nine (89) residents stated that the staff does help daily with his incontinence care. An interview with W1 stated the staff did help daily with R#4 incontinence care. W1 reported that R#4 had issues with behaviors. LPA España noted in an interview via telephone with W1 R#4 would refuse services at Studio Royale. Due to R#4 behavior issues, it was noted that W1 stated R#4 maybe did not ask for help and maybe does not recall if R#4 was left for an extended period within soiled diapers or soiled mattresses. Interviews with witness #1 along with Ten (10) out of Eighty-nine (89) residents reported no resident has been left in soiled diapers or soiled mattresses for an extended period. LPA España interviewed Eight (8) out of Fifty-one (51) staff members who claimed these allegations were false and that (R#4) was assisted daily incontinence care. Furthermore, per interviews with Ten (10) out of Eighty-nine (89) residents states that they have not been left in soiled mattress for an extended period as this is not allowed according to the Administrator. Based on information gathered, LPA did not find sufficient evidence to support allegation: Staff left resident soiled in urine for an extended period of time. Allegation: Staff left resident's mattress on the floor LPA España interviewed Eight (8) out of Fifty-one (51) staff members and conducted file reviews and observed apartments (#) 136; 129; 213; 230; 150; 212; 215; 214; and 218 which showed that every day during the day and evening apartments are checked cleaned. LPA España interviewed Eight (8) out of Fifty-one (51) staff members interviewed and all deny the allegation. LPA España observed of R#4 status at facility is considered longer a resident of Studio Royale and apartment 212 is currently vacant as of 11/02/2023. Based on information gathered, LPA did not find sufficient evidence to support allegation: Staff left resident's mattress on the floor. Continued on 9099-C Allegation: Staff did not keep the facility free of flies. LPA España toured the physical plant with S#2 at approximately 10:00 am - 1:45 pm., LPA observed apartments (#) 136; 129; 213; 230; 150; 212; 215; 214; and 218 which did not contain flies or odors in the room. LPA España did not observe flies in the hallway or kitchen. LPA España walked the grounds of the facility and noticed 8 wild cats. LPA España interviewed Eight (8) out of Fifty-one (51) staff members who stated there was no dogs located at the facility. LPA España determined that there are two (2) cats located in apartments #138 and #156. LPA España noted that the complainant stated flies’ present, however, unfounded claim. During the inspection visit on 11/02/23, the Department did observe Dewey Pest Control company invoices which show services: 10/17/23; 09/19/23; 08/21/2023; 06/01/2023; 09/12/2023; and Pest Sighting Log “Pest Control” with dates of 06/06/23; 06/13/23; 06/20/23; 06/30/23; 07/16/23; 08/27/23; 09/29/23; 10/27/23 etc. LPA España on behalf of the Department (CCLD) conducted an inspection of the entire facility and did not observe ants, flies, cockroaches, or bed bugs. The Department found the facility to be safe and sanitary. LPA España interviewed Eight (8) out of Fifty-one (51) staff members who claimed this allegation to be false. The facility has a contract with a reputable pest control company and has provided receipts to indicate that routine maintenance services are being performed. Ten (10) out of Eighty-nine (89) residents interviewed all verified that they (residents) have not encountered any pest activity at this facility and felt this is a safe and sanitary facility. Based on information gathered, LPA did not find sufficient evidence to support allegation: Staff did not keep the facility free of flies. At 4:45 pm exit interview conducted, and a copy of the report was provided to the facility.the state’s words, verbatim · CDSS document, Nov 2, 2023 · control 11-AS-20231025142545

Type of visit: Case Management - Other

On 11/02/2023 at 8:07 am Licensing Program Analyst (LPA) David España conducted an initiated a 10-day complaint investigation subsequent visit (11-AS-20231025142545). Upon arriving at the facility, LPA met with S#2 who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct inspections. LPA along with S#2 observed First floor bathroom #1 and #2 and Second Floor Bathroom #3 and #4. S#2 stated that First floor bathroom #1 and #2 and Second Floor Bathroom #3- and #4-bathroom ceiling fan/vent were working. LPA disagreed with statement and found that First-floor bathroom #1 and #2 and Second Floor Bathroom #3- and #4-bathroom ceiling fan/vent were not working. LPA observed movable bins used for storing or transporting solid wastes do not have tight-fitting covers on the containers; or in good repair. Therefore, based on LPA interviews, and observation and the LPA’s findings the facility was cited on 11/02/2023. According to the California Code of Regulations, Title 22, the following deficiency were cited: 87303(a) Maintenance and Operation 87303(f)(4) Maintenance and Operation See LIC 809-D for citation. Appeal Rights Discussed/An exit Interview was conducted. Report was issued.the state’s words, verbatim · CDSS document, Nov 2, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(a) · Plan of correction due date: Nov 17, 2023

(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. Based on observation and interview S#2 did safe and good repair facility, making it accessible to all residents which poses an immediate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Nov 2, 2023

Plan of correction: Licensee will take swift action having a safe and good repair facility, reducing the potential risk to the resident in care. The licensee stated all bathroom will be safe and good repair for residents, staff, and visitors moving forward email david.espana@dss.ca.gov.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87303(f)(4) · Plan of correction due date: Nov 17, 2023

(f)(4) Movable bins when used for storing or transporting solid wastes from the premises shall have tight-fitting covers on the containers; shall be in good repair; and shall be rodent-proof unless stored in a room or screened enclosure. Based on observation and interview S#2 did safe and good repair facility, making it accessible to all residents which poses an immediate health, safety, and personal rights risks to persons in care.the state’s words, verbatim · CDSS document, Nov 2, 2023

Plan of correction: Licensee will take swift action having a safe and good repair facility, reducing the potential risk to the resident in care. The licensee stated all bins will be safe and good repair for residents, staff, and visitors moving forward email david.espana@dss.ca.gov.

Allegation investigated: Facility staff do not ensure incontinent residents are cleaned properly. Facility staff transfer residents in a rough manor.

**This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 11/07/2022.** On 10/06/2023 at 12:31 pm Licensing Program Analyst (LPA) David España conducted a subsequent complaint investigation at the above facility to address the following allegations. LPA met with Administrator, Ernest “EJ” Lewis and explained the purpose of this visit was to deliver findings for this complaint. Upon arrival at the facility, LPA España conducted a risk assessment at the facility entrance. Based on the assessment, the facility is clear of Covid-19 infection. At approximately 10:55am LPA conducted a tour of the facility. During the course of the investigation at approximately 11:25am LPA spoke with five (05) staff members. Between 12:35pm – 1:45pm LPA interviewed ten (10) out of ninety-seven (97) residents. In addition, LPA Alvizar spoke with the witnesses that have pertinent information about the allegation. See LIC 9099-C on the next page Unsubstantiated Allegation #1: Facility staff do not ensure incontinent residents are cleaned properly. It was alleged that caregivers always rush when they clean up incontinent resident(s). Staff revealed that they always clean incontinent residents properly and on time. Nine (09) out of ten (10) residents indicated that they had no concerns regarding their incontinent care. Residents stated that the staff helps them and cleans them as needed. Based on inspection, observation, and interviews there is no sufficient information to verify the allegation. Therefore, the allegation is deemed unsubstantiated at this time. Allegation #2 Facility staff transfer residents in a rough manor. It was alleged that the staff cleaning resident #1 (R1) is not able to provide transfer assistance. Staff interviews revealed that R1 requires two (02) party assistance. All staff are trained to provide two (02) person assistance for the residents, as required. Nine (09) out of ten (10) Residents interviewed during investigation had no concerns regarding their transfer assistance. A review of facility records verified the information received from facility staff. Based on observation, interviews, available gathered from the records, there was no sufficient information and/or evidence to support the allegations. Therefore, the allegation is deemed unsubstantiated. No deficiencies were cited during this visit. Exit interview was conducted and a copy of report was issued to the Administrator, Ernest “EJ” Lewis. Allegation #1: Facility staff do not ensure incontinent residents are cleaned properly. It was alleged that caregivers always rush when they clean up incontinent resident(s). Staff revealed that they always clean incontinent residents properly and on time. Nine (09) out of ten (10) residents indicated that they had no concerns regarding their incontinent care. Residents stated that the staff helps them and cleans them as needed. Based on inspection, observation, and interviews there is no sufficient information to verify the allegation. Therefore, the allegation is deemed unsubstantiated at this time. Allegation #2 Facility staff transfer residents in a rough manor. It was alleged that the staff cleaning resident #1 (R1) is not able to provide transfer assistance. Staff interviews revealed that R1 requires two (02) party assistance. All staff are trained to provide two (02) person assistance for the residents, as required. Nine (09) out of ten (10) Residents interviewed during investigation had no concerns regarding their transfer assistance. A review of facility records verified the information received from facility staff. Based on observation, interviews, available gathered from the records, there was no sufficient information and/or evidence to support the allegations. Therefore, the allegation is deemed unsubstantiated. No deficiencies were cited during this visit. Exit interview was conducted and a copy of repot was issued to the Administrator, Ernest “EJ” Lewis.the state’s words, verbatim · CDSS document, Oct 6, 2023 · control 11-AS-20221103104439