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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306006089
Report Date: 10/31/2025
Date Signed: 10/31/2025 01:11:58 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/30/2025 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251030090606
FACILITY NAME:ROYAL SENIOR LIVINGFACILITY NUMBER:
306006089
ADMINISTRATOR:BASTANI, ASHKANFACILITY TYPE:
740
ADDRESS:31742 ISLE ROYAL DR.TELEPHONE:
(949) 302-3696
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 6DATE:
10/31/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ashkan BastaniTIME COMPLETED:
12:44 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff is not criminal record cleared
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA met with Administrator Ashkan Bastani and explained the reason for the visit. LPA toured the facility. LPA interviewed staff and residents. LPA reviewed facility records, staff records and the facility roster in Guardian background check system. The investigation into the allegation revealed the following. Facilty has 5 regular staff and 2 private caregivers who are employed by the families of Resident 1 and Resident 2. The 2 private caregivers (Staff 6 and Staff 7) both reported they do not work for an Agency and are employed directly by the families of the residents. Staff 1 and Staff 2 are background cleared and associated to the facility. The Administrator is associated to the facility. Staff 3, Staff 4 and Staff 5 are not associated to the facilty. Staff 3, Staff 4 and Staff 5 were not present at the facility during the visit. Staff 1, Staff 6 and Staff 7 were present at the facility when the LPA arrived. LPA observed both Staff 6 and Staff 7 leave the facility.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 22-AS-20251030090606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ROYAL SENIOR LIVING
FACILITY NUMBER: 306006089
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/31/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/01/2025
Section Cited
CCR
87355(e)(2)
1
2
3
4
5
6
7
87355(e)(2) All individuals subject to a criminal record review...(b) shall prior to working, residing or volunteering in a licensed facility: Obtain a California clearance or a criminal record exemption as required by the Department…
This requirement was not met evidenced by:
1
2
3
4
5
6
7
Licensee agrees to have all staff background cleared/trasnferred and associated to the facility before allowing any staff to work at the facility. Licensee agrees to sign a statement of understanding of CCR 87355 and to provide the signed statement by the POC due date.
8
9
10
11
12
13
14
Based on a record review Staff 6 does not have a California clearance or a as required by the Department. This poses an immediate health, safety and personal rights risk to residents in care.
8
9
10
11
12
13
14
Type A
11/01/2025
Section Cited
CCR
87355(e)(3)
1
2
3
4
5
6
7
87355 (e)(3) All individuals subject to a criminal record review... (b) shall prior to working, residing or volunteering in a licensed facility: (3)Request a transfer of a criminal record clearance...

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to have all staff background cleared/transferred and associated to the facility before allowing any staff to work at the facility. Licensee agrees to sign a statement of understanding of CCR 87355 and to provide the signed statement by the POC due date.
8
9
10
11
12
13
14
Based on a record review Staff 7 does not have a transfer of their criminal record clearance as required by the Department. This poses an immediate health, safety and personal rights risk to residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/30/2025 and conducted by Evaluator Joseph Alejandre
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251030090606

FACILITY NAME:ROYAL SENIOR LIVINGFACILITY NUMBER:
306006089
ADMINISTRATOR:BASTANI, ASHKANFACILITY TYPE:
740
ADDRESS:31742 ISLE ROYAL DR.TELEPHONE:
(949) 302-3696
CITY:LAGUNA NIGUELSTATE: CAZIP CODE:
92677
CAPACITY:6CENSUS: 6DATE:
10/31/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Ashkan BastaniTIME COMPLETED:
12:44 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Due to staff negligence, resident fell
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Joseph Alejandre made an unannounced visit to conduct the required 10-day visit to begin the investigation into the allegations listed above. LPA met with Administrator Ashkan Bastani and explained the reason for the visit. LPA toured the facility. LPA interviewed staff and residents. LPA reviewed facility and resident records. The investigation into the allegation revealed the following. Staff 1 reported that on October 15, 2025 Resident 2 fell. Staff 1 reported that Resident 2 was being assisted in the bathroom and pushed Staff 1 and then fell. Staff 1 reported they were trying to help Resident 2 use the bathroom and they pushed without warning and lost their balance and fell. LPA attempted to interview Resident 2 but they were unresponsive and did not answer any questions. No other witnesses were present during the incident. Staff 1 called 911 and Resident 2 was transported to the hospital and treated. Staff 2 reported that 911 was called and Resident 2's family and the Administrator were notified. Staff 2 reported they were at the facility but did not witness the incident. It is unclear why Resident 2 pushed Staff 1. Staff 1 and Staff 2 both reported that Resident 2 has not had any other falls. There is no evidence to support the allegation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20251030090606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ROYAL SENIOR LIVING
FACILITY NUMBER: 306006089
VISIT DATE: 10/31/2025
NARRATIVE
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5
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32
Based on the evidence gathered the allegation is deemed unsubstantiated. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation did or did not occur. An exit interview was conducted and a copy of the report provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20251030090606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ROYAL SENIOR LIVING
FACILITY NUMBER: 306006089
VISIT DATE: 10/31/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
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15
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32
 Based on the evidence gathered the preponderance of evidence standard has been met therefore the allegation is substantiated. Deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. Immediate civil penalties are being issued. An exit interview was conducted and a copy of the report along with appeal rights was provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Joseph Alejandre
LICENSING EVALUATOR SIGNATURE:

DATE: 10/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5