Royal Palms Care Home

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Michael Hood arrived at the facility unannounced on November 24, 2025 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPA conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and four (4) bathrooms for resident use. LPA observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 113 degrees F. LPA checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPA observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPA observed the backyard and perimeter of the care home to be free of clutter and debris. LPA observed smoke detectors and carbon monoxide detectors to be operational in the care home. Emergency exits were unobstructed during visit. Fire extinguishers and first aid kit is maintained and ready for emergency use. LPA reviewed two (2) residents' medications and observed medication storage to be locked away and inaccessible to the residents. LPA reviewed five (5) resident files and two (2) staff files. Facility has a current copy of certificate of liability insurance and LPA requested a copy. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit was interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, Nov 24, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Michael Hood and Cassie Mikkelson arrived at the facility unannounced on 11/15/24 to conduct a Required-1 Year Inspection utilizing the inspection tool. LPAs conducted an inspection of the care home to ensure compliance with Title 22 regulations. There are six (6) bedrooms and four (4) bathrooms for resident use. LPAs observed bedrooms to be properly furnished, with appropriate bedding and lighting. The bathrooms were in sanitary condition and properly maintained. Hot water temperature was observed to be 110.8 degrees F. LPAs checked the kitchen area for the ability to prepare and store food. Care home has required two (2) day perishable and seven (7) day non-perishable food supply on cite. LPAs observed knives, cleaning products, and other toxins to be locked away and inaccessible to residents. LPAs observed the backyard and perimeter of the care home to be free of clutter and debris. LPAs observed smoke detectors and carbon monoxide detectors to be operational in the care home. First aid kit is maintained and ready for emergency use. LPAs checked medication storage and found medication to be locked away and inaccessible to the residents. LPAs reviewed six (6) resident files and two (2) staff files. Facility has a current copy of certificate of liability insurance and LPAs requested a copy. As a result of this visit, no deficiencies were cited per California Code of Regulations, Title 22. Exit was interview conducted and copy of report given at the conclusion of this visit.the state’s words, verbatim · CDSS document, Nov 15, 2024

Allegation investigated: Untrained staff member is on the premises

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Daniela Podar, to deliver findings into the complaint allegation listed above. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: ** Report continued on 9099-C ** Substantiated LPA reviewed personnel records for staff members S1 and S2. LPA observed that S1 was missing eight (8) hours of dementia care training (with only two [2] hours completed) and four (4) hours of postural supports, restricted health conditions, and hospice care for the year of 2023. LPA observed that S2 had completed only twenty-eight (28) hours of initial training with six (6) hours of dementia care training and four (4) hours of postural supports, restricted health conditions, and hospice care since S2 was hired on 6/28/2024. Based on the information above, it was determined that the facility did not ensure caregivers were provided training in accordance with the Health and Safety code. Based on interviews conducted and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per Health and Safety Code §1569.625, deficiencies are being cited on the attached 9099-D page. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Signature on these forms acknowledges receipt of these documents. LPA interviewed Acting Administrator, Adela Crisan, staff member (S2), and resident (R1). All interviews conducted indicated that Acting Administrator was working on the premises everyday in the mornings and evenings during the absence of the Administrator. LPA observed an updated LIC 500 indicating days worked from Acting Administrator. LPA observed an LIC 308 designating Acting Administrator to fulfill the duties of the Administrator in their absence. Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegation is found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Aug 6, 2024 · control 59-AS-20240725155738

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.625(b)(1) · Plan of correction due date: Aug 21, 2024

§1569.625 Staff training; legislative findings; contents (b) (1) The department shall adopt regulations to require staff members of residential care facilities for the elderly who assist residents with personal activities of daily living to receive appropriate training. This training shall consist of 40 hours of training. A staff member shall complete 20 hours, including six hours specific to dementia care, as required by subdivision (a) of Section 1569.626 and four hours specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696, before working independently with residents. The remaining 20 hours shall include six hours specific to dementia care and shall be completed within the first four weeks of employment. The training coursework may utilize various methods of instruction, including, but not limited to, lectures, instructional videos, and interactive online courses. The additional 16 hours shall be hands-on training. This requirement is not met as evidenced by: Based on records reviewed, facility did not ensure that staff were acquiring all required initial trainings per Health and Safety Code, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 6, 2024

Plan of correction: Facility will ensure that all caregivers receive initial training in accordance with Health and Safety Code. Facility will also complete a statement of understanding regarding Health and Safety Code §1569.625 and submit to LPA by POC due date of 8/21/2024.

From the deficiency page — Deficiency type: Type B · Section cited: HSC 1569.625(b)(2) · Plan of correction due date: Aug 21, 2024

§1569.625 Staff training; legislative findings; contents (b) (2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Based on records reviewed, facility did not ensure that staff were acquiring all required annual trainings per Health and Safety Code, which poses a potential health, safety, and personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Aug 6, 2024

Plan of correction: Facility will ensure that all caregivers receive annual training in accordance with Health and Safety Code. Facility will also complete a statement of understanding regarding Health and Safety Code §1569.625 and submit to LPA by POC due date of 8/21/2024.

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Acting Administrator, Denisa Crisan, to obtain a signature relative to amending a report for an inspection conducted on 4/04/2024. LPA spoke with Licensee, Daniela Podar, via telephone, who gave permission to have Acting Administrator sign report. Signature was obtained for amended document during visit. Exit interview was conducted. A copy of this report and was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 23, 2024

Allegation investigated: Resident was hospitalized due to staff neglect

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Daniela Podar, to deliver findings into the complaint allegation listed above. During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation. The results of the investigation are as follows: ** Report continued on 9099-C ** Substantiated Per R1's records, R1 was admitted to the hospital on 8/28/2023 with a chief complaint of generalized weakness and Urinary Tract Infection (UTI). Records state that R1 reported to have abdominal pain and poor oral intake for the past three days prior to admission. On 9/3/2023, R1 was discharged from the hospital with a UTI and generalized weakness. Interview with R1's responsible party (RP) indicated that R1 moved to the facility on 7/8/2023 and was able to use their walker, go to the bathroom, and communicate with others in the home. RP stated that they noticed R1 getting weaker and having a harder time communicating. Interview with staff (S1) indicated that they noticed R1 getting weaker while working with R1. S1 stated that they did not notice any signs of a UTI regarding R1, but stated that they were not educated on the signs to look for related to a UTI. Administrator stated that R1 was showing signs of a UTI five days prior to being sent to the hospital on 8/28/2023. Follow-up interview with Administrator indicated that they noticed a change in condition with R1 five days prior to them being sent to the hospital on 8/28/2023, but did not suspect R1 having a UTI until three days prior to R1 being sent to the hospital on 8/28/2023. Administrator stated that the signs were not severe or urgent. RP and Administrator attempted to get a hold of R1's doctor to obtain an order for a urine sample. Administrator stated that R1 was showing signs of weakness and confusion, and R1's urine had an odor. It was not until 8/28/2023 that R1 was declining to eat meals. Administrator stated that once R1 stopped eating and missed two meals, Administrator called 911 and sent R1 to the hospital. Administrator indicated that R1 had prostate cancer and, therefore, had frequent UTIs. Administrator stated that R1 did not sustain a UTI due to anything done by the facility. Per R1’s Physician’s Report dated 7/6/2023, R1 was diagnosed with Dementia. R1’s records also indicated that R1 had prostate cancer and bowel and bladder impairment, requiring assistance with toileting. R1's records indicated that they were able to communicate their needs and ambulate with their walker. Based on interviews conducted and records reviewed, the preponderance of evidence standards have been met. Therefore, the above allegation is found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D page. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. Administrator's signature on these forms acknowledges receipt of these documents. A review of resident (R1's) Admission Agreement indicates the following regarding activities: "We shall offer an individualized program of recreational activities based on cooperative planning by the facility, family, caregivers, physician, and rapport and communication with the resident, and responsive, creative, and fluid planning of recreational activities. Residents and families are interviewed to gather information on their personal beliefs, culture, values, attention span and life experiences to determine activities that residents will enjoy and benefit from. The Administrator shall arrange for utilization of community recourses and promote resident participation in community-centered activities." During multiple visits conducted by LPA, LPA observed a sufficient amount of resources for activities for the residents and observed residents participating in activities at the facility. Interviews conducted with residents R2, R3, R4, and R5 indicated that the residents have plenty of activities to participate in at the facility and they have no concerns regarding activities at the facility. Interview with Administrator indicated that they gave a copy of R1's Admission Agreement to R1's responsible party (RP) a few days after the agreement was signed. Administrator stated that they gave R1's RP another copy of the agreement when R1 moved out of the facility. Administrator stated that R1's RP never requested another copy of R1's Admission Agreement during the time that R1 resided at the facility. LPA observed R1's Admission Agreement signed by R1's RP and dated for 7/8/2023. Based on interviews conducted, observations, and records reviewed, the preponderance of evidence standards have not been met. Therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that a complaint allegation is unsubstantiated means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Licensee gave permission to have Acting Administrator, Denisa Crisan, sign report. Exit interview was conducted with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents. On 9/1/2023, the Department received a phone call from R1's responsible party (RP) indicating that R1's personal property had yet to be removed from the facility as of 9/1/2023. During visit conducted on 3/13/2024, LPA obtained documentation from Administrator showing proof of refund to R1's RP in relation to the date in which R1's personal property was removed from the facility. Based on interviews conducted and records reviewed, the above allegation is found to be UNFOUNDED. A finding that the allegation is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. Exit interview was conducted with Administrator. A copy of this report was provided. Signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 4, 2024 · control 59-AS-20230905121646

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87466 · Plan of correction due date: Apr 5, 2024

87466 Observation of Resident - The licensee shall ensure that residents are regularly observed for changes in physical (...) functioning and that appropriate assistance is provided when such observation reveals unmet needs. (...) This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure resident R1 received timely medical attention after observation of unmet needs, which poses an immediate health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 4, 2024

Plan of correction: Facility will complete a statement of understanding regarding regulation 87466. Facility will submit statement to LPA by POC due date of 4/5/24.

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Michael Hood arrived at the facility and met with Administrator, Daniela Podar, to conduct a case management visit. During a separate investigation conducted by the Department, it was discovered multiple incidents occurred at the facility that were not reported to the Department. During records reviewed, it was discovered that resident (R1) was sent to the hospital on 7/18/2023 and 8/28/2023. It was also discovered that resident (R2) was sent to the hospital on 10/16/2023. During visit conducted on 4/4/2024, LPA requested copies of incident reports (SIRs) regarding the hospital visits for R1 and R2. Administrator could not produce requested documents during visit. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 809-D page regarding reporting requirements. Exit interview was conducted with Administrator. A copy of this report and appeal rights were provided. The ED’s signature on these forms acknowledges receipt of these documents.the state’s words, verbatim · CDSS document, Apr 4, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Apr 19, 2024

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. (...) This requirement is not met as evidenced by: Based on interviews conducted and records reviewed, the facility did not ensure to report multiple incidents to the licensing agency, which poses a potential health, safety, and personal rights risk to the residents in care.the state’s words, verbatim · CDSS document, Apr 4, 2024

Plan of correction: Facility will complete a statement of understanding regarding regulation 87211. Facility will submit statement to LPA by POC due date of 4/19/24.