The Royal Inn

Type of visit: Case Management - Deficiencies

On May 14, 2026, Licensing Program Analyst (LPA) Eboni Bentley conducted a case management after observing a deficiency while conducting complaint visit: 22-AS-20260504125007. Per record review and admission, the facility admitted a resident without obtaining a Physician's Report, Admissions Agreement, and additional required records in compliance with Title 22 regulations. Per interview with Administrator (Admin) Alan Shelley stated, the facility admitted a resident on a temporary basis of 5 days and did not obtain any written paperwork for the resident. During today's visit, LPA observed Resident #1 (R1) sitting in the common living room with three other residents. LPA also observed R1's personal belongings in R1's room that Admin previously identified as vacant. A deficiency was cited as per Title 22 Division 6 Chapter 8. An exit interview was conducted, and a copy of this report, LIC809-D, LIC811, and appeal rights were provided to Administrator Alan Shelley.the state’s words, verbatim · CDSS document, May 14, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87458(a) · Plan of correction due date: May 22, 2026

(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional .., to be kept in the resident's record. This requirement is not met as evidenced by: Based on interview and record review, no medical assessment, tuberculosis test, admission agreement, and required documents were completed for one of five residents. which poses a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, May 14, 2026

Plan of correction: Licensee will submit all required record (including medical assessment, tuberculosis test, admission agreement) for R1 by POC due date.

Type of visit: Required - 1 Year

On December 22, 2025, Licensing Program Analyst (LPA) Brandon Lopez made an unannounced visit to the facility to conduct the required annual inspection. LPA was greeted and granted entry into the facility by staff after explaining the purpose for the visit. House Manager (HM) Madison Shelley was present, and Licensee (LI) Alan Shelley later arrived to assist with the inspection. LPA observed that Alan Shelley has a valid Administrator certificate which expires on March 24, 2027. The facility is a Residential Care Facility for the Elderly (RCFE) licensed for six non-ambulatory residents and has a hospice waiver for four. The facility is a one story home with six private resident bedrooms, three shared resident bathrooms, a living room, a dining room, a kitchen, and an attached two car garage. LPA, accompanied by the HM, conducted a tour of the interior portions of the facility. On today's visit, there were six residents in care and two care giving staff present. LPA observed the resident relaxing in the living room and in their respective bedrooms. LPA observed the See Something, Say Something poster (PUB 475) mounted on the wall by the entryway of the facility. LPA inspected all six resident bedrooms and they were observed to be free of any hazards. LPA observed the resident bedrooms had all the required furnishings of a bed, a chair, a chest of drawers, and a lamp. LPA observed resident beds had clean linens and blankets. LPA observed additional linens and blankets are stored in a hallway closet. LPA inspected the three shared resident bathrooms. Resident bathrooms are clean. Resident bathrooms were equipped with grab bars and nonskid floor mats. Faucets and toilets were operational. Hot water temperature measured between 112.2 and 117.6 degrees Fahrenheit. LPA observed that the kitchen has a two day perishable and a seven day nonperishable food supply on hand. Kitchen appliances were clean and operational. LPA observed the five burner gas stove lights unassisted. CONTINUED ON LIC809-C LPA observed kitchen knives and sharps to be stored in a locked kitchen cabinet. LPA observed toxins and chemicals to be stored in a locked kitchen cabinet under the sink. A fire extinguisher is located in the kitchen and it was observed to be charged and purchased on November 29, 2025. LPA tested the individual smoke detectors and carbon monoxide detectors which tested operational. LPA observed the facility conducted their last emergency disaster drill on December 20, 2025. The centrally stored medication is kept in a locked cabinet located in the kitchen. LPA observed a First Aid Kit to be stored in the kitchen and it had all the required components. LPA observed the door leading to the attached two car garage to kept locked and inaccessible to residents in care. LPA observed the garage to be used for storage. LPA observed the facility has a three day emergency food and water supply stored in the garage. LPA, accompanied by the HM, conduct a tour of the exterior portion of the facility. LPA observed the exterior portion of the facility to be free of obstructions and hazards. LPA observed a shaded outdoor seating area with furniture for resident use. The perimeter gates of the facility are self-latching and can be open in an evacuation. There are no bodies of water on the premises. LPA reviewed all six resident files. LPA observed that there was no Medical Assessment on file for Resident #5 (R5). LPA reviewed the residents' medication and medication administration record. LPA reviewed five staff files. All staff are background cleared and associated to the facility. Based on the observations made during today's visit, one deficiency is being cited on the attached LIC809-D. An exit interview was conducted with House Manager Madison Shelley. A copy of the report and Appeal Rights were provided.the state’s words, verbatim · CDSS document, Dec 22, 2025

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Hanna Gough, Nancy Guillen and Licensing Program Manager Sheila Santos made an unannounced visit for the purpose of conducting a required annual Inspection. LPAs were greeted and granted entry by care provider Samantha Dimichina after explaining the purpose of the visit. Administrator (AD) Alan Shelley was notified via telephone and later arrived to assist with the inspection. LPAs observed the Administrator certificate was current and expires March 24, 2025. This is a Residential Care Facility for the Elderly (RCFE) licensed to 6 non-ambulatory residents with a hospice waiver for 4. The facility is a one story home with six resident bedrooms, three bathrooms, and an attached three car garage. While waiting for the AD, LPAs began review of the records. LPA Guillen reviewed four resident records. All the required documentation were present and current in the residents’ files reviewed. LPA reviewed two employee records. All employee’s present have a criminal record clearance and were associated to the facility. LPAs observed staff records reviewed have a current First Aid certificate. During the inspection, LPAs and AD conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: LPAs observed residents watching television in the living room and resting in their respective bedrooms. LPAs observed four residents in care and four staff present. LPAs observed the See Something Say Something Poster (PUB 475) mounted on the wall by the garage exit. LPA advised AD to have PUB 475 to be relocated to the entryway of the facility, AD proceeded to place the PUB 475 poster in the entry way of the facility; a technical advisory was given on today’s date. All resident bedrooms had the required furnishings. LPAs observed all resident beds had linens and blankets with additional linens stored in the hallway storage closet. LPAs observed bathrooms were clean and equipped with grab bars and non skid floor mats. LPAs observed all windows were appropriately screened. Continued on LIC 809-C Bathrooms were observed to be free of debris and mildew, faucets and toilets were operational. Water temperature tested between 113.3 and 119.1 degrees Fahrenheit in resident's bathrooms. LPAs toured the outside of the facility and observed outdoor passageways were free of obstruction. LPAs observed the backyard had a shaded sitting area with furniture for resident use. LPAs observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service date of February 29, 2024 and located by the kitchen. Gas stove, microwave, washer, and dryer were all inspected and observed to be operable. The garage is used for storage with a portion of the garage converted to a staff room which is kept locked and inaccessible to residents. Toxic chemicals, cleaning solutions, and disinfectants were observed to be locked and inaccessible to residents in the bathroom and under the kitchen sink. Medication cabinet was observed to be locked and centrally stored in the kitchen however, during the medication review, medication named PreserVision was being administered to a resident without a prescription present at the facility; a Deficiency was cited on this date. LPAs observed the First Aid Kit had all the required components. LPAs observed the facility conducted their last emergency disaster drill on October 1, 2024 and is conducted every 3 months. Based on the observations made during today’s inspection, a deficiency is being cited 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 was emailed to the Administrator due to a printer error.the state’s words, verbatim · CDSS document, Dec 31, 2024

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.

Type of visit: Case Management - Other

Licensing Program Analysts (LPAs) Hanna Gough, Nancy Guillen and Licensing Program Manager Sheila Santos were notified of a death that occurred while conducting the annual visit today. Per staff Samantha, R1 passed away today and was under hospice care. Mortuary arrived to pick up R1. Facility provided a death report LIC624A at the time of our visit. Per death report, death was caused by natural causes, cardiac arrest. An exit interview was conducted and a copy of this report was explained and provided via email due to printer error.the state’s words, verbatim · CDSS document, Dec 31, 2024