Heritage Royale

Type of visit: Case Management - Other

On 01/07/2026, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced pre-licensing inspection visit. LPA met with administrator Katie Eiseman and explained the purpose of today's visit. Pre licensing inspection conducted. Report is reviewed with Katie and a copy is provided.the state’s words, verbatim · CDSS document, Jan 7, 2026

Type of visit: Required - 1 Year

On 08/23/2025, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection visit. LPA met with administrator Katie Eiseman and explained the purpose of today's visit. This is a single level facility approved all residents to be non-amblatory and three hospice residents. There is one resident on hospice at this time. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer between the stove and refrigerator. Medications are observed to be locked in a lockable storage area in the office of the facility. Perishable and non-perishable food items are observed as in place. There are additional refrigerators and freezers in the garage area which also carry additional food supplies. First aid kit is observed as complete with required items located in the office area of the facility. LPA observed that there are multiple fire extinguishers in place inspected 08/19/2025, smoke detectors, carbon monoxide detectors are observed in place through out the facility, and central heating system. PPE and additional food supplies are observed as in place. Laundry area is also observed as fully operational. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted on 06/23/2025. Water temperature was measured at 110F in two common resident bathrooms and a private bathroom in a vacant resident room. Continued on next page... Page 2 LPA observed rooms numerous resident rooms and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Three resident bedrooms contain a full bathroom. Resident linen supplies are observed as in place. Cleaning supplies are also observed as locked inaccessible to residents in care. There is a live in staff area for sleeping also located in the office. Facility does not handle resident monies. Three resident files and two staff files are reviewed as current. Medications are inspected and observed to be current and in order. The following updated forms are requested to be submitted to CCLD by 08/30/2025: • LIC308 Designation of responsible staff person • LIC500 Staff Schedule No citations issued during today's visit. Report is reviewed with Katie and a copy is provided.the state’s words, verbatim · CDSS document, Aug 23, 2025

Type of visit: Required - 1 Year

On 07/18/2024, Licensing Program Analyst (LPA) Jaime Vado conducted an unannounced annual inspection visit. LPA met with caregiver Lojie Fernando upon arrival and explained the purpose of today's visit. Around 2pm the administrator Katie Eiseman arrived and met with LPA. LPA was allowed entry into the facility. This is a single level facility approved all residents to be non-amblatory and three hospice residents. The physical plant was toured inside and outside of the facility to ensure the safety of the residents. LPA observed the facility kitchen which is clean and observed appliances are in good repair. Knives are stored and locked in the kitchen in a drawer between the stove and refrigerator. Medications are observed to be locked in a lockable storage area in the office of the facility. Perishable and non-perishable food items are observed as in place. There are additional refrigerators and freezers in the garage area which also carry additional food supplies. First aid kit is observed as complete with required items located in the office area of the facility. LPA observed that there are multiple fire extinguishers in place inspected 08/15/2024, smoke detectors, carbon monoxide detectors are observed in place through out the facility, and central heating system. PPE and additional food supplies are observed as in place. Laundry area is also observed as fully operational. Emergency exit routes are observed inside and outside to be free and clear of obstructions. Last emergency/disaster drill was conducted on 06/24/2025. Water temperature was measured at 110F in two common resident bathrooms and a private bathroom in a vacant resident room. Continued on next page... Page 2 LPA observed rooms numerous resident rooms and all appeared clean, free of odors, and contained all the required furniture per regulatory recommendations. Three resident bedrooms contain a full bathroom. Resident linen supplies are observed as in place. Cleaning supplies are also observed as locked inaccessible to residents in care. There is a live in staff area for sleeping also located in the office. Facility does not handle resident monies. Four of four resident files are reviewed as current. Medications are inspected and observed to be current and in order. The following updated forms are requested to be submitted to CCLD by 08/28/2024: • Copy of updated Administrator Certificates • Copy of facility's liability insurance • LIC308 Designation of responsible staff person • LIC610E Emergency Disaster Plan • LIC500 Staff Schedule • Copy of control of property No citations issued during today's visit. Report is reviewed with Katie and a copy is provided.the state’s words, verbatim · CDSS document, Aug 21, 2024

Type of visit: Case Management - Other

As per initial annual inspection on 1/19/24, LPA Jeung provided amended Facility Evaluation Report . Due to technical difficulties on 1/19/24, first page of Facility Evaluation Report was inaccurate. Amended page 1 of Facility Evaluation Report is provided, along with additional 3 pages of Advisory Notes. There are no changes or amendments to subsequent pages of Report of 1/19/24.the state’s words, verbatim · CDSS document, Jan 23, 2024

Type of visit: Case Management - Incident

In response to Death Report submitted to CCLD on 1/3/24 of client's death on 12/26/23, LPA Jeung requested to review MD report and appraisal, which were previously requested but not received. Client experienced a medical emergency, and staff contacted client's responsible party, who directed staff NOT to call 9-1-1. Client had a Physician's Orders for Life-Sustaining Treatment (POLST) on file, which stated that comfort measures only should be provided. MD report is not available for LPA to review, so cause of death is unknown. Deficiency of the California Code of Regulations, Title 22, is cited on a following page.the state’s words, verbatim · CDSS document, Jan 19, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(g) · Plan of correction due date: Feb 2, 2024

INCIDENTAL MEDICAL CARE The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4). This requirement was not met, as staff failed to call 9-1-1 on 12/26/23 when client #1 experienced a medical emergency. Licensee failed to ensure that 9-1-1 was called to determine what, if any measures should be taken. This posed a potential health, safety or personal rights risk to client in care.the state’s words, verbatim · CDSS document, Jan 19, 2024

Plan of correction: Plan of correction to be submitted to CCLD BY DUE DATE

Type of visit: Required - 1 Year

LPA Audrey Jeung toured facility and grounds. There are no accessible bodies of water or fire safety hazards observed. Medications, toxins and sharps are stored appropriately and inaccessible to clients, a comfortable room temperature is maintained, and lighting is sufficient for safety. Carbon monoxide detector is tested and operable. First-aid kit is maintained and complete. This facility is one level, with 6 client bedrooms, 4 full bathrooms, kitchen, living/dining room, staff room, and attached 2-car garage, where the washer and dryer are located; the staff room is adjacent to garage and has 3 beds. The backyard is paved and enclosed by a wood fence. Medications are stored in locked cabinet in staff room and chemicals and cleaners are stored in locked garage cabinet. An undated Disaster and Mass Casualty Plan is posted, and copy is given to LPA. Criminal record clearances or exemptions for facility staff or other individuals who have client contact have been reviewed. Katie Eisemen is a certified RCFE administrator (x 1/25) that oversees facility operations. Client records and Staff training records are reviewed. The following licensing forms are to be updated and returned to CCL by 2/2/24: • LIC 309 Administrative Organization • LIC 500 Personnel Report • Infection Control Plan (signed and dated) • Proof of liability insurance for $1 million per incident and $3 million in annual aggregate Deficiencies of the CA Code of Regulations, Title 22 are cited on following pages. Also, see 8 Advisory Notes issued.the state’s words, verbatim · CDSS document, Jan 19, 2024