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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601917
Report Date: 01/06/2026
Date Signed: 01/06/2026 04:54:18 PM

Document Has Been Signed on 01/06/2026 04:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME:ROYAL ASSISTED LIVINGFACILITY NUMBER:
198601917
ADMINISTRATOR/
DIRECTOR:		SIMLA MEHTAFACILITY TYPE:
740
ADDRESS:4925 AVENUE BTELEPHONE:
(424) 247-8001
CITY:TORRANCESTATE: CAZIP CODE:
90505
CAPACITY: 6CENSUS: 6DATE:
01/06/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Enrico SantosTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 01/06/26 at 1:15pm, Licensing Program Analyst (LPA) Wendy Gibbs conducted an unannounced Required 1-year Annual Visit to the facility listed above. LPA met with Designee, Enrico Santos, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The facility is licensed to serve six (6) non-ambulatory residents ages 60 and above, five (5) of which may be bedridden, with an approved hospice waiver for six (6) residents.
Physical Plant/Structure The facility is a single-story structure located in a residential neighborhood. It consists of the following: four (4) residents’ rooms, a staff room, four (4) bathrooms, living area, dining area, kitchen and outside covered patio area with a table and chairs. There is an attached garage with access only through the front of the garage and it is used for storage. The garage has a washer and dryer for laundry and an additional refrigerator. LPA observed all outside walkways to be clean, clear, and free of obstructions, hazards, and debris. LPA observed the gates on the side of the facility open easily from the inside to exit. LPA did not observe any bodies of water on the premises.
Bedrooms LPA inspected all bedrooms and found them to be clean and in good repair. All rooms had the required furniture including bed(s), dresser(s), nightstand(s), chair(s), and ample storage space for resident’s personal belongings. LPA observed beds have the required linens including a mattress cover, fitted sheets, blankets, comforter, and pillows. LPA observed beds and bedding supplies were in good repair and an adequate supply was available. All bedrooms were observed with ample lighting.
Bathrooms LPA inspected all bathrooms and found them to be to be within Title 22 regulations and were clean and operational. All safety handrails are secured. LPA observed showers with nonskid mats and a shower chair. The water temperature measured 111.3-degrees, 113.3-degrees, 114.8-degrees and
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ROYAL ASSISTED LIVING
FACILITY NUMBER: 198601917
VISIT DATE: 01/06/2026
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115.3-degrees Fahrenheit. The department observed an ample supply of towels and hygiene products for residents.
Kitchen LPA inspected the kitchen and found it to be clean and sanitary. LPA observed an ample supply of cookware, dining ware, and cutlery in good repair. LPA observed a 3-day supply of perishable foods and a 7-day supply of nonperishable foods properly packaged and labeled. LPA observed all knives and sharps secured in a locked drawer in the kitchen. LPA observed cleaning supplies secured in a locked cabinet in the kitchen under the sink. The water temperature in the kitchen measured 112.9-degrees Fahrenheit.
Common Areas All rooms were observed clean and appropriately furnished at the time of visit. The dining room has a large table and chairs to accommodate all residents. LPA observed games and activities in a cabinet in the dining room available for resident use. The living room has two (2) couches and two (2) recliners to accommodate residents. LPA observed a fireplace in the living room that is screened and inaccessible to residents. All walkways and hallways, in the facility, were observed clean, clear, and free of obstructions or hazards. A comfortable temperature was maintained in the facility.
Medications LPA observed all centrally stored medication secured in a locked cabinet in the kitchen and are inaccessible to residents. Medications were observed in their original containers. LPA reviewed the medications for four (4) residents and found them to be consistent with physician’s orders and centrally stored medications list.
File Review LPA reviewed six (6) resident files and found they contained the required documents. LPA reviewed the administrator file and three (3) staff files and found they contained the required documents, training, clearance, and certifications. The administrator’s Administrator Certificate 7029005750 is valid till 11/20/2026. LPA reviewed and received a copy of the facility Liability Insurance through Acord that is valid till 05/16/26. LPA observed licensing fees are current.
Safety LPA observed a fully charged fire extinguisher, in the dining room, last serviced on 01/03/26. The last emergency drill was conducted on 01/01/26. The last Fire Prevention Inspection by the Torrance Fire Department was conducted on 01/03/25. Smoke detectors and carbon monoxide detectors were observed operable. The First Aid Kit was observed to contain the required items and a current manual. When doors leading outside are opened, there is an alarm that sounds to inform staff that a door has been opened. The facility has a working landline telephone. LPA observed all mandated signs posted throughout the facility.
Infection Control Upon entry, LPA observed a sanitizing station and visitor sign in log. The sanitizing station has masks and gloves available. LPA observed sanitizing stations throughout the facility. LPA
NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: ROYAL ASSISTED LIVING
FACILITY NUMBER: 198601917
VISIT DATE: 01/06/2026
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observed infection control signs posted throughout the facility. LPA observed a 30-day supply of Personal Protective Equipment (PPE) stored in a closet.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the department did not observe any deficiencies, therefore no citations were issued at this time.

An exit interview was conducted with Designee, Enrico Santos, and a copy of this report was provided.

NAME OF LICENSING PROGRAM MANAGER: Eva M Alvarez
NAME OF LICENSING PROGRAM ANALYST: Wendy Gibbs
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2026
LIC809 (FAS) - (06/04)
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