Royal Senior Living 2

Type of visit: Required - 1 Year

On today's date Licensing Program Analyst (LPA) William Vanegas made an unannounced visit for the purposes of conducting an annual inspection. Upon arrival LPA was greeted and granted entry to the facility by care giver staff. LPA explained the purpose of the visit and facility staff advised Administrator (AD) Ashkan Bastani of my arrival. AD arrived shortly after to assist with the tour of the facility. LPA began a tour of the facility and observed the following AD has a valid Administrator certificate that expires on October 22,2027. The facility is a one storied home with six bedrooms, one of which is a staff room, and five of which are used for residents in care, three restrooms, and a two car attached garage. LPA observed facility to have all required postings in the facility along the entryway hallway. LPA observed the PUB475 (See something, say something) poster posted on the wall. As well as the long term care ombudsman poster, resident rights, and rights to have a resident council posted on the wall. LPA observed kitchen area to be clean and free of any mildew and debris. LPA observed there to be a gas stove, microwave, refrigerator, dishwasher, washer, and dryer. All were observed to be in good condition and tested operational. LPA obsereved a two day supply of perishable food, and a seven day supply of non-perishable food. LPA Observed all resident rooms to be clean and free of any debris. LPA obsereved residents to have all required furnishings such as a chest of drawers, a bed, clean linens in good repair; meaning no strains or tares, a reading lamp, a chair, and enough storage space to store personal belongings. LPA observed rooms large enough to walk about freely, and no furniture blocking the entry ways. CONTINUED ON LIC809C LPA Observed resident restrooms to be clean and free of any mildew and debris. LPA observed water faucets and toilets to be operational. LPA observed restrooms to have all required furnishings such as slip resistant floor matts, grab bars, and a shower chair. Hot water temperature tested between 115.4 and 117.6 degrees fahrenheit. LPA observed all smoke detectors and carbon monoxide detectors to be operational and in good repair. LPA observed all fire extinguishers to be fully charged and up to date. LPA conducted a tour of the outside of the facility and observed the following. There is an outdoor shaded sitting area, no obstructions or debris along the emergency side exits. Side gates are self latching and unlocked. Backyard is large enough to participate in outdoor activities upon resident request. LPA observed first aid kit to have all required items such as adhesive tape, scissors, tweezers, bandages, a thermometer, and a first-aid manual. LPA reviewed two resident files, and resident files had all required documents. Staff files did not have all required documents, one staff present was not associated to the facility. A deficiency was issued and staff not associated left the facility. LPA reviewed medication administration record and medications, all medications are documented correctly. Per LPA review all medications are being administered per physicians orders. Based on observations made during today's inspection deficiencies will be issued per title 22 division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights were provided to the facility. A copy of this report will also be mailed to the facility.the state’s words, verbatim · CDSS document, Feb 11, 2026

Type of visit: Prelicensing

Licensing Program Analysts (LPAs) Hanna Gough and Rose Ruppert made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPAs met with Administrator (AD) Ashkan Bastani. An application to operate a Residential Care Facility for the Elderly (RCFE) was received by our agency on August 21, 2024 for a total capacity of six non-ambulatory residents. The facility is a one story home with five resident and one caregiver bedrooms, three bathrooms, a living room, a kitchen, a dining area, and an attached two car garage. LPAs measured the temperatures in three of three bathrooms and were between 117.5 to 117.8 degrees Fahrenheit. All exiting doors had alarm notifications. There are backyard exit gates on the sides of the house that are self-latching and unlocked with auditory alarms. There is a shaded seating area and LPAs did not observe any obstacles or hazards in the backyard. The fire extinguisher was serviced and charged on October 15, 2024. LPAs observed the See Something, Say Something poster (PUB 475), Personal Rights, Weekly Activities Calendar, Menu and Emergency Disaster Plan in the facility mounted on the wall in the hallway. Resident bedrooms had the required furnishings. LPAs observed all beds had linens and blankets. All toxic chemicals, cleaning solutions, and disinfectants are inaccessible to residents and will be stored and locked underneath the kitchen sink. Medications will be stored in a locked cabinet. The first aid kit has all the required elements. Reading materials and games were observed in the living room with a phone and tablet for resident use. A supply of seven-day non-perishable food was observed and will be maintained on hand. AD will provide two-day perishables upon receipt of residents in care. Smoke detectors and carbon monoxide detectors tested operational. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. LPAs conducted the Component Three Orientation with AD. AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted and a copy of this report was provided to Licensee.the state’s words, verbatim · CDSS document, Jan 22, 2025

Type of visit: Office

COMP II by CAB successfully completed Method: Phone Call at CAB Applicant/administrator participated in COMP II at CAB telephone call with analyst at CAB. Identification of the applicant and administrator was verified by presenting photo ID via phone. During COMP II, applicant and administrator confirmed the understanding of Title 22. Component II was successfully completed. Applicant and administrator were advised to email/fax signed LIC 809 with copy of photo ID to CAB. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility operation: License type, client/resident populations, and program 2. Staff qualifications and responsibilities 3. Applicant and Administrator qualifications 4. Program policy: Abuse, admission agreement, medication management, reporting incidents to CCL, restricted & prohibited conditions 5. Grievances, Complaints, Community resources 6. Physical plant, food service 7. Application document review and technical assistance: Criminal record clearance, Health screening, Fire clearance, First Aid/CPR certificate, Administrator certificate, Financial verification, Pre-licensing inspection, Compliance history, Control of propertythe state’s words, verbatim · CDSS document, Dec 5, 2024